Provider Demographics
NPI:1861736472
Name:CUMBERLAND MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:CUMBERLAND MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-822-7252
Mailing Address - Street 1:1705 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829-8601
Mailing Address - Country:US
Mailing Address - Phone:715-822-7500
Mailing Address - Fax:715-822-7221
Practice Address - Street 1:1705 16TH AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829-8601
Practice Address - Country:US
Practice Address - Phone:715-822-7500
Practice Address - Fax:715-822-7221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11011600Medicaid
WI521353Medicare Oscar/Certification