Provider Demographics
NPI:1316158850
Name:DODGE COUNTY MEDICAL FACILITIES
Entity type:Organization
Organization Name:DODGE COUNTY MEDICAL FACILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-386-3400
Mailing Address - Street 1:198 COUNTY DF
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-9515
Mailing Address - Country:US
Mailing Address - Phone:920-386-3400
Mailing Address - Fax:920-386-4168
Practice Address - Street 1:199 HOME RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-1401
Practice Address - Country:US
Practice Address - Phone:920-386-3400
Practice Address - Fax:920-386-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41650900Medicaid
WI1062720001Medicare ID - Type UnspecifiedCLEARVIEW DME
WI41650900Medicaid