NPIMap

Organization Active NPI

Tri-County Memorial Hospital, Inc.

  • Rural Health Clinic/Center
  • Whitehall, WI
National Provider Identifier
1417201864
Registry record updated Nov 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TRI-COUNTY MEMORIAL HOSPITAL, INC.
Practice address
18606 Ervin St
Whitehall, WI 54773-8613
Phone
(715) 538-4355
Fax
(715) 538-2151
NPI assigned
Nov 7, 2012
Last updated
Nov 3, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
TRI-COUNTY MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 3, 2018

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

Authorized official

Name
Roxane Kay Schleich
Title
Cfo, Regional
Phone
(608) 775-3839

Specialties & licenses 1

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

Addresses

Primary practice location

18606 Ervin St
Whitehall, WI 54773-8613

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 WI3 enrollments

Enrollment records 3

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
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
This NPI is an additional NPI on the enrollment
Practice locations: Whitehall, WI
O20130130000000 WI Part A Provider - Rural Health Clinic 4587642418 Practice locations: Whitehall, WI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1417201864. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
18601 Lincoln St
Whitehall, WI 54773-8605
Main/Primary Hospital Location

Rural health clinic certification: CCN 528553

Legal name
TRI-COUNTY MEMORIAL HOSPITAL INC
Doing business as
GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS- WHITEHALL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2013
Last certification
Oct 1, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 17, 1930 in WI
Enrollment address
18606 Ervin St
Whitehall, WI 54773-8613
Related CCNs
521316

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Gundersen Tri-County Hospital & ClinicsCCN 521316 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Tri County Mem Hosp

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Lynette Speltz Individual Corporate DirectorBoard Member Jan 1, 2026
Beth Marie Lisowski Individual Corporate DirectorBoard Member Nov 28, 2016
Corporate DirectorBoard Member Nov 1, 2016
Timothy Holtan Individual Corporate DirectorBoard Member Jan 1, 2025
Bellin Gundersen Health System Inc Organization, La Crosse, WI Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 30, 2022 100%
Operational/Managerial Control Nov 30, 2022 100%
Laura Kloss Individual Corporate DirectorBoard Member Jan 1, 2025
Marlys Kolstad Individual Corporate Director Apr 28, 2020
Therese Binfet Individual Corporate DirectorBoard Member Jan 1, 2024
Gundersen Lutheran Administrative Services, Inc. Organization, Lacrosse, WI Non-profit Operational/Managerial Control Jul 1, 2009 100%
5% Or Greater Mortgage Interest Jan 1, 2013 100%
Operational/Managerial Control Jan 1, 2013 100%
Kristy Millering Individual Corporate OfficerFinance Administrator Sep 24, 2024
W-2 Managing EmployeeFinance Admin Sep 24, 2024
Gundersen Lutheran Health System Inc Organization, La Crosse, WI Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2009 100%
Operational/Managerial Control Aug 19, 2009
5% Or Greater Direct Ownership Interest Jan 1, 2013 100%
Operational/Managerial Control Jan 1, 2013 100%
Vickie M Bakalars Individual Corporate DirectorBoard Member Jun 1, 2020
Corporate DirectorBoard Member Jan 1, 2021
Marilu Bintz Individual Corporate DirectorBoard Member May 1, 2017
Daniel Coenen Individual Corporate OfficerAdministrator / Ceo Oct 1, 2024
Kimberly B Breidenbach Individual Corporate DirectorBoard Member Nov 25, 2014

Owners & managing parties with NPI records 1

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

Facilities with the same owner 49

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 49

Practitioners & affiliated clinicians

Practitioners 334

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 334

Affiliated clinicians 97

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541203200000",
    "number": "1417201864",
    "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",
            "fax_number": "715-538-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18606 ERVIN ST",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547738613",
            "telephone_number": "715-538-4355",
            "fax_number": "715-538-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-COUNTY MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2012-11-07",
        "last_updated": "2018-11-03",
        "status": "A",
        "authorized_official_last_name": "SCHLEICH",
        "authorized_official_first_name": "ROXANE",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "CFO, REGIONAL",
        "authorized_official_telephone_number": "608-775-3839"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitehall, WI

Sources for this page

Verify at the official NPI Registry.