Provider Demographics
NPI:1912199340
Name:BELOIT HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:BELOIT HEALTH SYSTEM, INC
Other - Org Name:OCCUPATIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER PATIENT ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JB
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-364-5123
Mailing Address - Street 1:1650 LEE LN
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3935
Mailing Address - Country:US
Mailing Address - Phone:608-364-4666
Mailing Address - Fax:
Practice Address - Street 1:1650 LEE LN
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3935
Practice Address - Country:US
Practice Address - Phone:608-364-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE73470Medicare UPIN