Organization
BEAVER DAM COMMUNITY HOSPITALS INC
Active
Parent organization
MARSHFIELD CLINIC HEALTH SYSTEM INC
Other names
(Inactive) Hillside Unit Pharmacy
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
707 S UNIVERSITY AVE, BEAVER DAM, WI 53916-3027
(920) 887-4146
(920) 887-6613
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
282N00000X
General Acute Care Hospital
5344-042
WV
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5111923
NABP NUMBER
WI
01
—
5344-042
STATE LICENSE #
WI
Enumeration date
04/12/2007
Last updated
03/07/2023
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