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General NPI Number Information
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NPI Number | 1548248313
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Entity Type | Organization
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Legal Business Name | THEDACARE MEDICAL CENTER - SHAWANO, INC.
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 100 COUNTY ROAD B
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City | SHAWANO
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State | WI
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Zip | 54166-7072
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Country | US
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Telephone | 715-524-2169
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Fax | 715-526-7140
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Provider Business Mailing Address
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Address Line | 100 COUNTY ROAD B
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City | SHAWANO
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State | WI
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Zip | 54166-7072
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Country | US
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Telephone | 715-524-2169
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Fax | 715-526-7140
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Authorized Official
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Title or Position | CFO
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Name | WILLIAM FLETT
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Credential |
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Telephone | 920-454-4013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 510
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License Number State | WI
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