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General NPI Number Information
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NPI Number | 1275902546
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Entity Type | Organization
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Legal Business Name | BEAVER DAM COMMUNITY HOSPITALS INC
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 705 S UNIVERSITY AVE STE 180
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City | BEAVER DAM
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State | WI
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Zip | 53916-3001
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Country | US
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Telephone | 920-356-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N OAK AVE PROVIDER ENROLLMENT SERVICES - SHP FL 2
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City | MARSHFIELD
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State | WI
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Zip | 54449-5703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP REVENUE CYCLE OPERATIONS
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Name | JOLYN MUNSON
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Credential |
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Telephone | 605-328-6585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9335-42
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License Number State | WI
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