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1013995521

NPI Code Detail

MEDICARE: THEDACARE MEDICAL CENTER - WAUPACA, INC.

MEDICARE: THEDACARE MEDICAL CENTER - WAUPACA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	1038	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC8778	OTHER	WI	RAILROAD MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	701137	OTHER	WI	NETWORK HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013995521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEDACARE MEDICAL CENTER - WAUPACA, INC.

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

Provider Business Practice Location Address
First Line	:	800 RIVERSIDE DR
Second Line	:
City	:	WAUPACA
State	:	WI
Zip	:	54981-1943
Country	:	US
Telephone Number	:	715-258-1000
Fax Number	:	715-258-1626

Authorized Official
Title or Position	:	CFO
Name	:	MR. WILLIAM FLETT
Credential	:
Telephone Number	:	920-454-4013

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	01/02/2024

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Directions to “THEDACARE MEDICAL CENTER - WAUPACA, INC. ” Practice Location

Language	Start Address	Practice Location

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