Healthcare Provider Details

I. General information

NPI: 1972188555
Provider Name (Legal Business Name): BEAVER DAM COMMUNITY HOSPITALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S UNIVERSITY AVE
BEAVER DAM WI
53916-3027
US

IV. Provider business mailing address

1000 N OAK AVE PROVIDER ENROLLMENT SERVICES - SHP FL 2
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-7181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOLYN MUNSON
Title or Position: VP REVENUE CYCLE OPERATIONS
Credential:
Phone: 605-328-6585