Healthcare Provider Details

I. General information

NPI: 1093368607
Provider Name (Legal Business Name): NEW MEDICAL CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GATEWAY DR, STE A
WAUPUN WI
53963-2276
US

IV. Provider business mailing address

160 GATEWAY DR, STE A
WAUPUN WI
53963-2276
US

V. Phone/Fax

Practice location:
  • Phone: 920-324-9899
  • Fax: 920-324-9898
Mailing address:
  • Phone: 920-324-9899
  • Fax: 920-324-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL L BLOHOWIAK
Title or Position: PRESIDENT
Credential: DC
Phone: 920-324-9899