Provider Demographics
NPI:1780675116
Name:BEAVER DAM EMERGENCY MEDICINE S.C.
Entity Type:Organization
Organization Name:BEAVER DAM EMERGENCY MEDICINE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:608-833-2085
Mailing Address - Street 1:7546 RED FOX TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1860
Mailing Address - Country:US
Mailing Address - Phone:608-833-2085
Mailing Address - Fax:608-833-2082
Practice Address - Street 1:707 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3027
Practice Address - Country:US
Practice Address - Phone:920-887-6606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty