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Organization
BEAVER DAM COMMUNITY HOSPITALS INC
Active
Organization
BEAVER DAM COMMUNITY HOSPITALS INC
Active
Parent organization
MARSHFIELD CLINIC HEALTH SYSTEM INC
Other names
(Inactive) Marshfield Medical Center - Beaver Dam Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARSHFIELD CLINIC HEALTH SYSTEM INC
Authorized official
GORDON T EDWARDS (CFO/COO/AO)
(715) 387-5823
Entity
Organization
Contact information
Practice address
130 WARREN ST STE 132, BEAVER DAM, WI 53916
(920) 887-7181
(920) 887-6833
Mailing address
1000 N OAK AVE, ATTN: PROVIDER ENROLLMENT SERVICES/WWP, MARSHFIELD, WI 54449-5703
(715) 389-0660
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
851-800
WI
Other
Enumeration date
02/09/2010
Last updated
03/03/2022
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