Provider Demographics
NPI:1285770016
Name:MILE BLUFF MEDICAL CENTER INC
Entity type:Organization
Organization Name:MILE BLUFF MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-847-1452
Mailing Address - Street 1:1050 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1931
Mailing Address - Country:US
Mailing Address - Phone:608-847-6161
Mailing Address - Fax:608-847-2079
Practice Address - Street 1:1515 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:ELROY
Practice Address - State:WI
Practice Address - Zip Code:53929-1011
Practice Address - Country:US
Practice Address - Phone:608-847-6161
Practice Address - Fax:608-847-2079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILE BLUFF MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134332B00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43052700Medicaid
WI=========053OtherBCBS PROVIDER NUMBER
=========OtherEMPLOYER TAX ID NUMBER
WI=========Z4OtherUNITY PROVIDER NUMBER
WI=========Z5OtherUNITY PROVIDER NUMBER
WI000057025Medicare PIN
WI=========Z5OtherUNITY PROVIDER NUMBER