MEDICARE: THEDACARE MEDICAL CENTER - WAUPACA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1063837557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEDACARE MEDICAL CENTER - WAUPACA, INC.

Provider Business Mailing Address
First Line	:	6501 CITY WEST PKWY
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3248
Country	:	US
Telephone Number	:	952-653-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 CITY WEST PKWY
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3248
Country	:	US
Telephone Number	:	952-653-2525
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. WILLIAM FLETT
Credential	:
Telephone Number	:	920-454-4013

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	01/03/2024

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