1013995521 NPI number — THEDACARE MEDICAL CENTER - WAUPACA, INC.

Table of content: (NPI 1013995521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013995521 NPI number — THEDACARE MEDICAL CENTER - WAUPACA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THEDACARE MEDICAL CENTER - WAUPACA, INC.
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:
1013995521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 NEENAH CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEENAH
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54956-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-830-5900
Provider Business Mailing Address Fax Number:
920-830-5910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUPACA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54981-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-258-1000
Provider Business Practice Location Address Fax Number:
715-258-1626
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLETT
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
920-454-4013

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  1038 , 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: CC8778 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 11018600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 701137 . This is a "NETWORK HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 62766600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32942600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42245200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1019845001 . This is a "AMERICHOICE MEDICAID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 11018610 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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