1821589342 NPI number — DODGE COUNTY MEDICAL FACILITIES

Table of content: (NPI 1821589342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821589342 NPI number — DODGE COUNTY MEDICAL FACILITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DODGE COUNTY MEDICAL FACILITIES
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:
1821589342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
198 COUNTY DF
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNEAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53039-9515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-386-3400
Provider Business Mailing Address Fax Number:
920-386-4168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
198 COUNTY DF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNEAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53039-9515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-386-3400
Provider Business Practice Location Address Fax Number:
920-386-4168
Provider Enumeration Date:
05/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HOOPER
Authorized Official First Name:
JANE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
920-386-3400

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  5050 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5050 . This is a "314000000X" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com