NPIMap

Organization Active NPI

Mile Bluff Medical Center Inc

  • Rural Health Clinic/Center
  • New Lisbon, WI
National Provider Identifier
1104162841
Registry record updated Apr 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
134 Issued in WI
Legal business name
MILE BLUFF MEDICAL CENTER INC
Practice address
901 W Bridge St
New Lisbon, WI 53950-1083
Phone
(608) 847-6161
Fax
(608) 847-2079
NPI assigned
Dec 28, 2012
Organization subpart
Yes
Parent organization
MILE BLUFF MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 13, 2026

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

Authorized official

Name
Thomas Kaminski
Title
VP/Cfo
Phone
(608) 847-1452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 134 WI Primary

Addresses

Primary practice location

901 W Bridge St
New Lisbon, WI 53950-1083

Mailing address

1050 Division St
Mauston, WI 53948-1931
Phone (608) 847-6161

Other names 1

  • Mile Bluff New Lisbon Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130117000278 WI Part A Provider - Rural Health Clinic 8527971399 Practice locations: New Lisbon, WI

Rural health clinic certification: CCN 528550

Legal name
MILE BLUFF MEDICAL CENTER INC
Doing business as
NEW LISBON FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 31, 2012
Last certification
Apr 5, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 4, 1962 in WI
Enrollment address
901 W Bridge Street
New Lisbon, WI 53950-1083
Related CCNs
520109

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0394122New Lisbon Family Medical Center901 W Bridge St, New Lisbon, WI 53950AccreditationDec 9, 2027

National Provider Directory

National Provider Directory
Part of
Mile Bluff Medical Ctr Inc

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniel W Kattenbraker Individual Corporate DirectorMD and Board Member Feb 1, 2010
James Michael Grannell Individual Corporate DirectorBoard Member May 1, 2022
Jenna K Sebranek Individual Corporate Director Oct 1, 2022
Dara Beth Bartels Individual Corporate OfficerPresident Dec 1, 2022
W-2 Managing Employee Mar 3, 2019
Larry J Willer Individual Corporate DirectorBoard Secretary May 1, 2007
Dennis D Loging Individual Corporate DirectorBoard Member Mar 1, 2016
Cassondra L Kovach Individual Corporate DirectorMD and Board Member Jan 1, 2013
Michael L Pech Individual Corporate Director Jul 1, 2022
Randy C Scott Individual Corporate DirectorBoard Member May 1, 2013
Rebecca Richards-Bria Individual Corporate Director Apr 1, 2022
Michelle Herek Individual Corporate DirectorBoard Member Apr 1, 2022
Lori Murphy Individual Corporate Director Oct 1, 2018

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776038400000",
    "number": "1104162841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 DIVISION ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481931",
            "telephone_number": "608-847-6161",
            "fax_number": "608-847-2079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W BRIDGE ST",
            "city": "NEW LISBON",
            "state": "WI",
            "postal_code": "539501083",
            "telephone_number": "608-847-6161",
            "fax_number": "608-847-2079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE BLUFF MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILE BLUFF MEDICAL CENTER INC",
        "enumeration_date": "2012-12-28",
        "last_updated": "2026-04-13",
        "certification_date": "2026-04-13",
        "status": "A",
        "authorized_official_last_name": "KAMINSKI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "608-847-1452"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WI",
            "license": "134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile Bluff New Lisbon Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Lisbon, WI

Sources for this page

Verify at the official NPI Registry.