1114120201 NPI number — DICKINSON COUNTY HEALTHCARE SYSTEM

Table of content: (NPI 1114120201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114120201 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:
Provider Other Organization Name Type Code:
6
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:
1114120201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2025
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 COORDINATOR 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:
2845 US HIGHWAY 2 41
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
BARK RIVER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49807-9661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-466-2650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRESSLER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
COO, AO
Authorized Official Telephone Number:
715-975-6018

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  220020 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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