1225306418 NPI number — DICKINSON COUNTY HEALTHCARE SYSTEM

Table of content: (NPI 1225306418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225306418 NPI number — DICKINSON COUNTY HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DICKINSON COUNTY HEALTHCARE SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARSHFIELD MEDICAL CENTER - DICKINSON SLEEP MEDICINE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225306418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N OAK AVE
Provider Second Line Business Mailing Address:
ATTN: PROVIDER ENROLLMENT SERVICES - SHP FL 2
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54449-5703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-389-0660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 S CARPENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49802-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-776-5480
Provider Business Practice Location Address Fax Number:
906-228-0203
Provider Enumeration Date:
12/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
906-776-5500

Provider Taxonomy Codes

  • Taxonomy code: 207QS1201X , with the licence number:  5101008443 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080S0012X , with the licence number: 4301088606 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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