NPIMap

Organization Active NPI

Tri-County Memorial Hospital, Inc.

  • Clinic/Center
  • Independence, WI
National Provider Identifier
1073335642
Registry record updated Oct 25, 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
35791 Osseo Rd
Independence, WI 54747-9096
Phone
(715) 985-2351
Fax
(715) 985-3880
NPI assigned
Oct 25, 2024
Last updated
Oct 25, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TRI-COUNTY MEMORIAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Authorized official

Name
Daniel Coenen
Title
Administrator
Phone
(715) 538-4361

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

35791 Osseo Rd
Independence, WI 54747-9096

Mailing address

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

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 Hos6 organizations share this tax ID, including this one
Part of
Tri County Memorial Hos

Other organizations with this tax ID 5

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

Locations

19475 Silver Creek Rd
Galesville, WI 54630
Phone (608) 582-2211

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

Practitioners & affiliated clinicians

Practitioners 330

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 330

NPI Registry JSON

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

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1073335642",
    "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": "35791 OSSEO RD",
            "city": "INDEPENDENCE",
            "state": "WI",
            "postal_code": "547479096",
            "telephone_number": "715-985-2351",
            "fax_number": "715-985-3880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-COUNTY MEMORIAL HOSPITAL INC",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "COENEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-538-4361"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.