=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801887013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DICKINSON COUNTY HEALTHCARE SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2005
-----------------------------------------------------
Last Update Date | 07/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1721 S STEPHENSON AVE
-----------------------------------------------------
City | IRON MOUNTAIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49801-3637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-774-1313
-----------------------------------------------------
Fax | 906-776-5639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 N OAK AVE ATTN: PROVIDER ENROLLMENT SERVICES - SHP 2ND FL
-----------------------------------------------------
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 | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 220020
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------