Healthcare Provider Details

I. General information

NPI: 1447907456
Provider Name (Legal Business Name): BEAVER DAM COMMUNITY HOSPITALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CORPORATE DR
BEAVER DAM WI
53916-3115
US

IV. Provider business mailing address

1000 N OAK AVE PROVIDER ENROLLMENT SERVICES - SHP FL2
MARSHFIELD WI
54449-5703
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-1151
  • Fax:
Mailing address:
  • Phone: 715-389-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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