Tri-County Memorial Hospital, Inc.
Organization Active NPI Critical Access Hospital · Whitehall, WI
NPI 1124063573 · NPPES record last updated Nov 3, 2018
Key facts
- NPI
- 1124063573
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 1019 (WI)
- Legal business name
- TRI-COUNTY MEMORIAL HOSPITAL, INC.
- Practice address
- 18601 Lincoln St
Whitehall, WI 54773-8605 - Phone
- (715) 538-4361
- Fax
- (715) 538-2271
- NPI assigned
- Jun 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Roxane Kay Schleich
- Title
- Cfo, Regional
- Phone
- (608) 775-3839
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 3
Facilities with the same owner 49
Practitioners 200
-
Alexa V Becherer, MS
-
Zachary Ronald Clements, D.O.
-
David M Dawson, DPM
-
Kevin D Hanson, MD
-
Jamal Janjua, M.D
-
Megan Klomps-McClung, D.O.
-
Kelly Marie Lay, NP
-
Caitlin Marie Luttropp, PA-C
-
Andrea R Maliszewski, AUD
-
Tanya Mudgett, NP
-
Kurt R Oettel, MD
-
Benjamin Orozco, MD
-
Thanh Pham, M.D.
-
Ganesh Ram, PA
-
Janel Lanae Ward, MD
-
Mark R Zellmer, PA-C
-
Justin Christopher Dyer, M.D.
-
Kathy Ann Boe, NP
Affiliated clinicians 97
-
Scott Robert Bassuener, M.D.
-
Keith Edward Baynes, M.D.
-
Marcus William Bickford, M.D.
-
Rebecca L Blank, PA
-
Stephen John Bloechl, M.D.
-
Kathy Ann Boe, NP
-
Joel A Burnet, DO
-
Aaron M.K. Butler, M.D.
-
Michael K Case, MD
-
Ross Michael Cerniglia, M.D.
-
Zachary Ronald Clements, D.O.
-
Daniel L Cox, MD
-
David M Dawson, DPM
-
Murray Sean Donovan, M.D.
-
Jennifer Lynn Drexler, D.O.
-
Collin Driscoll, M.D.
Medicare Care Compare: Hospital
- Listed as
- Gundersen Tri-County Hospital & Clinics
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WI
Hospital certification: CCN 521316
- Legal name
- TRI-COUNTY MEMORIAL HOSPITAL INC
- Doing business as
- GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Sep 23, 2001
- Last certification
- Aug 30, 2023
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 18601 Lincoln St
Whitehall, WI 54773-8605
Hospital certification: CCN 52Z316
- Legal name
- TRI-COUNTY MEMORIAL HOSPITAL INC
- Doing business as
- GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 17, 1930 in WI
- Enrollment address
- 18601 Lincoln St
Whitehall, WI 54773-8605
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Lynette Speltz |
Corporate Director |
Jan 1, 2026 | |
| Beth Marie Lisowski |
Corporate Director |
Nov 28, 2016 | |
| Corporate Director |
Nov 1, 2016 | ||
| Timothy Holtan |
Corporate Director |
Jan 1, 2025 | |
| Bellin Gundersen Health System Inc |
5% Or Greater Indirect Ownership Interest | Nov 30, 2022 | 100% |
| Operational/Managerial Control | Nov 30, 2022 | 100% | |
| Laura Kloss |
Corporate Director |
Jan 1, 2025 | |
| Marlys Kolstad |
Corporate Director | Apr 28, 2020 | |
| Therese Binfet |
Corporate Director |
Jan 1, 2024 | |
| Gundersen Lutheran Administrative Services, Inc. |
Operational/Managerial Control | Jul 1, 2009 | 100% |
| Kristy Millering |
Corporate Officer |
Sep 24, 2024 | |
| W-2 Managing Employee |
Sep 24, 2024 | ||
| Gundersen Lutheran Health System Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2009 | 100% |
| Operational/Managerial Control | Aug 19, 2009 | ||
| Operational/Managerial Control | Aug 19, 2009 | 100% | |
| Vickie M Bakalars |
Corporate Director |
Jun 1, 2020 | |
| Corporate Director |
Jan 1, 2021 | ||
| Marilu Bintz |
Corporate Director |
May 1, 2017 | |
| Daniel Coenen |
Corporate Officer |
Oct 1, 2024 | |
| Kimberly B Breidenbach |
Corporate Director |
Nov 25, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20090901000361 | WI | Part a Provider - Critical Access Hospital | 4587642418 |
Receives reassigned benefits from 78 practitioners 2 other NPIs on this enrollment Practice locations: Whitehall, WI |
| O20090901000557 | WI | Part a Provider - Critical Access Hospital | 4587642418 | Practice locations: Whitehall, WI |
National Provider Directory
Locations
226 N 2nd St
La Crescent, MN 55947
Phone (507) 895-6610
716 W Adams St
Black River Falls, WI 54615
Phone (715) 284-9409
724 Denton St
La Crosse, WI 54601
Phone (608) 775-1000
18601 Lincoln St
Ste 100
Whitehall, WI 54773
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 1019 | WI | |
| Critical Access Hospital | 282NC0060X | 1019 | WI | Yes |
Addresses
Primary practice location
18601 Lincoln St
Whitehall, WI 54773-8605
Mailing address
18601 Lincoln St.
Whitehall, WI 54773
Phone (715) 538-4361
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11016000 | Medicaid | WI | |
| 11016010 | Medicaid | WI |
Other providers in Whitehall, WI
- Trempealeau County Human Services
- Tri County Memorial Hospital
- Tri-County Memorial Hospital
- Tri-County Memorial Hospital Inc
- Tri-County Memorial Hospital Inc
- Tri-County Memorial Hospital, Inc.
- Tri-County Memorial Hospital, Inc.
- Brian S Vike
- Pamela A Weltzien
- Joshua M Werry
All providers in Whitehall, WI · Critical Access Hospital in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.