Healthcare Provider Details

I. General information

NPI: 1598081846
Provider Name (Legal Business Name): RIPON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST
WAUPUN WI
53963-1601
US

IV. Provider business mailing address

1001 W MAIN ST
WAUPUN WI
53963-1601
US

V. Phone/Fax

Practice location:
  • Phone: 920-324-9301
  • Fax:
Mailing address:
  • Phone: 920-324-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIMRY JOHNSRUD
Title or Position: INTERIM COO
Credential:
Phone: 920-748-9190