=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336183052
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DICKINSON COUNTY HEALTHCARE SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 07/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 OLIVE AVE
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54121-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-380-7411
-----------------------------------------------------
Fax | 715-528-5592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 N OAK AVE ATTN: PROVIDER ENROLLMENT COORDINATOR SHP FL 2
-----------------------------------------------------
City | MARSHFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54449-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-389-0660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP REVENUE CYCLE OPERATIONS
-----------------------------------------------------
Name | JOLYN MUNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-328-6585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------