Gundersen Lutheran Medical Center Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

GUNDERSEN LUTHERAN MEDICAL CENTER INC

Practice address

711 W Adams St
Black River Falls, WI 54615-9108

Phone

(608) 782-7300

NPI assigned

Mar 27, 2013

Organization subpart

Yes

Parent organization

GUNDERSEN LUTHERAN MEDICAL CENTER INCAs reported in NPPES

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

Authorized official

Name

Kari B Adank

Title

Cco

Phone

(608) 775-8025

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GLMC BLACK RIVER FALLS RENAL DIALYSIS Other name

Part of

Lutheran HSP-la Crosse

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1063755171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015467",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159108",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUNDERSEN LUTHERAN MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN LUTHERAN MEDICAL CENTER INC",
        "enumeration_date": "2013-03-27",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "ADANK",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "608-775-8025"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42063500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLMC BLACK RIVER FALLS RENAL DIALYSIS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Heather Gjerseth
• Michelle Goetting
• Kayla Mae Goettl
• Donald Robert Greengrass Sr., SAC
• Gundersen Clinic, LTD. (Gundersen Lutheran Eye Clinic - Black River Falls)
• Barbara Jeanne Hagenbrock, RPH
• Heather Lee Haines, MA, LPC
• Cheryl Lynn Hanson-Liu, MS
• Amber Jo Hanson
• Jennifer Christine Hanson, DNP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Black River Falls, WI
• Providers in Black River Falls, WI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.