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General NPI Number Information
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NPI Number | 1558031856
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Entity Type | Organization
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Legal Business Name | THEDACARE MEDICAL CENTER - WAUPACA, INC.
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 800 RIVERSIDE DR
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City | WAUPACA
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State | WI
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Zip | 54981-1943
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Country | US
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Telephone | 715-258-1600
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Fax | 920-993-5032
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Provider Business Mailing Address
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Address Line | 800 RIVERSIDE DR
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City | WAUPACA
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State | WI
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Zip | 54981-1943
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Country | US
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Telephone | 715-258-1600
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Fax | 920-993-5032
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Authorized Official
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Title or Position | CFO
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Name | MR. 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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