NPIMap

Organization Active NPI

Tri-County Memorial Hospital Inc

  • Clinic/Center
  • Mondovi, WI
National Provider Identifier
1013748060
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
TRI-COUNTY MEMORIAL HOSPITAL INC
Practice address
250 State Road 37
Mondovi, WI 54755-2611
Phone
(715) 538-4361
NPI assigned
Aug 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Dan D Coenen
Title
Administrator
Phone
(715) 538-4361

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

250 State Road 37
Mondovi, WI 54755-2611

Mailing address

18601 Lincoln St
Whitehall, WI 54773-8605
Phone (715) 538-4361

Other names 1

  • Emplify Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040708000696 WI Part B Supplier - Clinic/Group Practice 4587642418 Receives reassigned benefits from 330 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galesville, WI; Whitehall, WI; Pigeon Falls, WI; Mondovi, WI; Milwaukee, WI; Mequon, WI; Independence, WI; Elm Grove, WI…

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Tri County Memorial Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

250 State Road 37
Mondovi, WI 54755
Phone (715) 538-4355

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1013748060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18601 LINCOLN ST",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547738605",
            "telephone_number": "715-538-4361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 STATE ROAD 37",
            "city": "MONDOVI",
            "state": "WI",
            "postal_code": "547552611",
            "telephone_number": "715-538-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-12",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "COENEN",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-538-4361",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emplify Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mondovi, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.