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Beaver Dam Community Hospitals Inc

Organization Active NPI Pharmacy · Beaver Dam, WI

NPI 1720202864 · NPPES record last updated Mar 7, 2023

Key facts

NPI
1720202864
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
Legal business name
BEAVER DAM COMMUNITY HOSPITALS INC
Practice address
707 S University Ave
Beaver Dam, WI 53916-3027
Phone
(920) 887-4146
Fax
(920) 887-6613
NPI assigned
Apr 12, 2007
Organization subpart
Yes
Parent organization (as reported)
MARSHFIELD CLINIC HEALTH SYSTEM INC

Authorized official

Name
Gordon T Edwards
Title
Cfo/Coo/Ao
Phone
(715) 387-5823

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Corporate family (same tax ID) 8

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Beaver Dam Comm Hosp Inc (9 organizations share this tax ID)
Part of
Marshfield Clinic Health System Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 5344-042 WV
Pharmacy 333600000X Yes

Addresses

Primary practice location

707 S University Ave
Beaver Dam, WI 53916-3027

Mailing address

1000 N Oak Ave
Attn: Provider Enrollment Services/WWP
Marshfield, WI 54449-5703
Phone (715) 389-0660

Other identifiers

IdentifierTypeStateIssuer
5344-042OtherWISTATE LICENSE #
5111923OtherWINABP NUMBER
5111923OtherWIWI MEDICAID NUMBER

Other names

  • (Inactive) Hillside Unit Pharmacy Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 7, 2023.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1720202864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "address_2": "ATTN: PROVIDER ENROLLMENT SERVICES/WWP",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495703",
            "telephone_number": "715-389-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 S UNIVERSITY AVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163027",
            "telephone_number": "920-887-4146",
            "fax_number": "920-887-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER DAM COMMUNITY HOSPITALS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARSHFIELD CLINIC HEALTH SYSTEM INC",
        "enumeration_date": "2007-04-12",
        "last_updated": "2023-03-07",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO/COO/AO",
        "authorized_official_telephone_number": "715-387-5823"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WV",
            "license": "5344-042",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "5344-042",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "5111923",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI MEDICAID NUMBER",
            "identifier": "5111923",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "(Inactive) Hillside Unit Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "(Inactive) Hillside Unit Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaver Dam, WI

All providers in Beaver Dam, WI · Pharmacy in Wisconsin

Sources for this page

Verify at the official NPI Registry.