Organization
BEAVER DAM COMMUNITY HOSPITALS, INC
Active
Parent organization
MARSHFIELD CLINIC HEALTH SYSTEM INC
Other names
(Inactive) MMC - Beaver Dam - Movement & Ortho, Rehab, PT/OT/ST
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
705 S UNIVERSITY AVE STE 150, BEAVER DAM, WI 53916
(920) 219-4009
(920) 219-9709
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
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
11/23/2010
Last updated
03/02/2022
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