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General NPI Number Information
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NPI Number | 1295771780
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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 | 06/21/2006
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 707 S UNIVERSITY AVE
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City | BEAVER DAM
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State | WI
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Zip | 53916-3089
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Country | US
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Telephone | 920-887-4053
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N OAK AVE ATTN: PROVIDER ENROLLMENT SERVICES SHP FL2
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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 | 715-389-0660
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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 | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 5344-42
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5344-42
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License Number State | WI
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Taxonomy #3
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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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