Healthcare Provider Details

I. General information

NPI: 1487726311
Provider Name (Legal Business Name): DODGE COUNTY MEDICAL FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HOME ROAD
JUNEAU WI
53039-1401
US

IV. Provider business mailing address

198 COUNTY DF
JUNEAU WI
53039-9515
US

V. Phone/Fax

Practice location:
  • Phone: 920-386-3400
  • Fax: 920-386-3800
Mailing address:
  • Phone: 920-386-3400
  • Fax: 920-386-4168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2380
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JANE ELIZABETH HOOPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 920-386-3400