Provider Demographics
NPI:1538384466
Name:AMERY REGIONAL MEDICAL CENTER, INC
Entity type:Organization
Organization Name:AMERY REGIONAL MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:715-268-8000
Mailing Address - Street 1:265 GRIFFIN ST E
Mailing Address - Street 2:AMERY REGIONAL MEDICAL CENTER
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1439
Mailing Address - Country:US
Mailing Address - Phone:715-268-8000
Mailing Address - Fax:715-268-0311
Practice Address - Street 1:550 MARTIN AVE W
Practice Address - Street 2:TURTLE LAKE MEDICAL CLINIC
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-9069
Practice Address - Country:US
Practice Address - Phone:715-986-4101
Practice Address - Fax:715-986-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI528561OtherRURAL HEALTH CLINIC
WI1861552010OtherCARLA VOSSEN NP
52DD397211OtherCLIA
WI1720050909OtherVERONICA MINIER, MD
000000496Medicare PIN