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General NPI Number Information
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NPI Number | 1912109836
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Entity Type | Organization
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Legal Business Name | IHC BEAVER DAM EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 09/19/2025
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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 | 53916-3027
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Country | US
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Telephone | 954-939-5000
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Fax | 484-342-5201
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Provider Business Mailing Address
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Address Line | PO BOX 80268
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City | PHILADELPHIA
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State | PA
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Zip | 19101-1268
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Country | US
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Telephone | 954-939-5000
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Fax | 484-342-5201
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | CHRISTOPHER KENNEDY
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Credential |
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Telephone | 207-807-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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