NPIMap

Organization Active NPI

Vernon Memorial Healthcare, Inc.

Doing business as Kickapoo Valley Medical Clinic - VMH

  • Rural Health Clinic/Center
  • Soldiers Grove, WI
National Provider Identifier
1376549824
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
VERNON MEMORIAL HEALTHCARE, INC.
Doing business as
Kickapoo Valley Medical Clinic - VMH
Vernon Health - Soldiers Grove Clinic
Practice address
102 Sunset Ave
Soldiers Grove, WI 54655-1400
Phone
(608) 624-5203
Fax
(608) 624-5572
NPI assigned
Jun 21, 2005
Last updated
Feb 2, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
VERNON MEMORIAL HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

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

Authorized official

Name
David Hartberg
Title
Ceo
Phone
(608) 637-4796

Specialties & licenses 1

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

Addresses

Primary practice location

102 Sunset Ave
Soldiers Grove, WI 54655-1400

Mailing address

507 S Main St
Viroqua, WI 54665-2059
Phone (608) 637-2101

Other names 2

  • Kickapoo Valley Medical Clinic - VMH Doing business as
  • Vernon Health - Soldiers Grove Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040420001202 WI Part B Supplier - Clinic/Group Practice 8325958416 Receives reassigned benefits from 59 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Farge, WI; Soldiers Grove, WI; Viroqua, WI; Westby, WI
O20100602000502 WI Part A Provider - Rural Health Clinic 8325958416 Practice locations: Soldiers Grove, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376549824. Details of each certification follow.

Rural health clinic certification: CCN 523999

Legal name
VERNON MEMORIAL HEALTHCARE INC
Doing business as
VERNON HEALTH - SOLDIERS GROVE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 7, 1997
Last certification
Jul 9, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1952 in WI
Enrollment address
102 Sunset Ave
Soldiers Grove, WI 54655-1400
Related CCNs
521348

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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

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
52D0396431Vernon Health Soldiers Grove Clinic102 Sunset Ave, Soldiers Grove, WI 54655ComplianceJul 19, 2028

National Provider Directory

National Provider Directory
Part of
Vernon Memorial Hospital

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Joan Peterson Individual Corporate DirectorDirector Jan 1, 2024
David J Hartberg Individual Corporate DirectorCeo Dec 9, 2019
W-2 Managing EmployeeCeo Dec 9, 2019
Peter R Hughes Individual Corporate DirectorDirector Jan 1, 2022
Paul Woodward Individual Corporate DirectorDirector Jan 1, 2023
Ashley D Lagerquist Individual W-2 Managing EmployeeDirector, Revenue Cycle Apr 8, 2013
Tom Weston Individual Corporate Director Jan 1, 2020
Kimberly Turmire Individual Corporate DirectorDirector Jan 1, 2023
Steven Michaels Individual Corporate DirectorDirector Jan 1, 2023
Vicki Anderson Individual Corporate Director Jan 1, 2020
Jay Vossetig Individual Corporate DirectorDirector Jan 1, 2024
Scott P Leckey Individual Corporate DirectorCfo Jul 15, 2021
W-2 Managing EmployeeCfo Jul 15, 2021
Michele Engh Individual Corporate DirectorDirector Jan 1, 2024
Vernon Memorial Healthcare Inc Organization, Viroqua, WI Non-profit Operational/Managerial Control Jul 1, 2010
Staci Kring Individual Corporate DirectorDirector Jan 1, 2024
Paul Larsen Individual Corporate Director Jan 1, 2020
Ashley Hagen Individual Corporate DirectorDirector May 8, 2021
W-2 Managing EmployeeMedical Staff Coordinator May 8, 2021

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769990400000",
    "number": "1376549824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 S MAIN ST",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "546652059",
            "telephone_number": "608-637-2101",
            "fax_number": "608-638-5077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 SUNSET AVE",
            "city": "SOLDIERS GROVE",
            "state": "WI",
            "postal_code": "546551400",
            "telephone_number": "608-624-5203",
            "fax_number": "608-624-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON MEMORIAL HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VERNON MEMORIAL HEALTHCARE, INC.",
        "enumeration_date": "2005-06-21",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A",
        "authorized_official_last_name": "HARTBERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "608-637-4796"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kickapoo Valley Medical Clinic - VMH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vernon Health - Soldiers Grove Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Soldiers Grove, WI

Sources for this page

Verify at the official NPI Registry.