Healthcare Provider Details

I. General information

NPI: 1548248644
Provider Name (Legal Business Name): WAUPUN MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/12/2022
Certification Date: 03/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W BROWN ST
WAUPUN WI
53963-1702
US

IV. Provider business mailing address

620 W BROWN ST
WAUPUN WI
53963-1702
US

V. Phone/Fax

Practice location:
  • Phone: 920-324-5581
  • Fax: 920-926-8885
Mailing address:
  • Phone: 920-324-5581
  • Fax: 920-926-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: BONNIE R SCHMITZ
Title or Position: CFO
Credential:
Phone: 920-926-4480