Provider Demographics
NPI: | 1437169752 |
---|---|
Name: | TOWNSHEND, ALICE M (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ALICE |
Middle Name: | M |
Last Name: | TOWNSHEND |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1905 E. HUEBBE PARKWAY |
Mailing Address - Street 2: | BELOIT HEALTH SYSTEM INC |
Mailing Address - City: | BELOIT |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53511-1842 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 608-364-2200 |
Mailing Address - Fax: | 608-364-1255 |
Practice Address - Street 1: | 1905 E. HUEBBE PARKWAY |
Practice Address - Street 2: | BELOIT HEALTH SYSTEM INC |
Practice Address - City: | BELOIT |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53511-1842 |
Practice Address - Country: | US |
Practice Address - Phone: | 608-364-2200 |
Practice Address - Fax: | 608-364-1255 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-09 |
Last Update Date: | 2011-10-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 37362020 | 207W00000X |
IL | 036-089431 | 207W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
11155 | Other | DEAN HEALTH PLAN HMO | |
WI | 1437169752 | Medicaid | |
F88052 | Medicare UPIN | ||
11155 | Other | DEAN HEALTH PLAN HMO |