Provider Information for 1720202864
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BEAVER DAM COMMUNITY HOSPITALS INC
Other Names:Doing Business As:(INACTIVE) HILLSIDE UNIT PHARMACYOrganization Subpart: YES
NPI: 1720202864
Last Updated: 2023-03-07
Certification Date: 2022-03-03
Certification Date: 2022-03-03
Details
| Name | Value | ||||||||||||||||
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| NPI | 1720202864 | ||||||||||||||||
| Enumeration Date | 2007-04-12 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Authorized Official Information | Name: GORDON T EDWARDS Title: CFO/COO/AO Phone: 7153875823 | ||||||||||||||||
| Mailing Address | 1000 N OAK AVE ATTN: PROVIDER ENROLLMENT SERVICES/WWP MARSHFIELD, WI 54449-5703 United States Phone: 715-389-0660 | Fax: | ||||||||||||||||
| Primary Practice Address | 707 S UNIVERSITY AVE BEAVER DAM, WI 53916-3027 United States Phone: 920-887-4146 | Fax:920-887-6613 | ||||||||||||||||
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