Healthcare Provider Details

I. General information

NPI: 1346362068
Provider Name (Legal Business Name): BELOIT MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LEE LN
BELOIT WI
53511-3935
US

IV. Provider business mailing address

1650 LEE LN
BELOIT WI
53511-3935
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIA EGEBRECHT
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 608-364-1615