Healthcare Provider Details

I. General information

NPI: 1831070408
Provider Name (Legal Business Name): JAVON BEA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E INMAN PKWY STE 1
BELOIT WI
53511-1774
US

IV. Provider business mailing address

1400 E INMAN PKWY STE 1
BELOIT WI
53511-1774
US

V. Phone/Fax

Practice location:
  • Phone: 608-361-6705
  • Fax: 608-361-6722
Mailing address:
  • Phone: 608-361-6705
  • Fax: 608-361-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHANNON DUNPHY-ALEXANDER
Title or Position: CFO
Credential:
Phone: 608-757-4126