THEDACARE INCORPORATED NPI 1356424683

NPI Information

NPI: 1356424683
Provider Name: THEDACARE, INCORPORATED
Classification: Non-Pharmacy Dispensing Site - 332900000X
Entity Type: Organization
Doing Business As: THEDACARE PHYSICIANS PEDIATRICS
CLIA Number: 52D0861163
Address: 2701 E ENTERPRISE AVE
APPLETON, WI
ZIP 54913
Phone: (920) 954-2551

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NPI Details

THEDACARE, INCORPORATED is a non pharmacy dispensing site in Appleton, WI. The provider is a site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) THEDACARE, INCORPORATED NPI is 1356424683. The provider is registered as an organization entity type.
The provider Is Doing Business As Thedacare Physicians Pediatrics.

The provider's business location address is:

2701 E ENTERPRISE AVE
APPLETON, WI
ZIP 54913-729
Phone: (920) 954-2551
Fax: (920) 954-2554

The provider's authorized official is William Flett .
The authorized official title is Cfo and has the following contact phone number (920) 454-4013.

The CLIA number assigned to this NPI record is 52D0861163 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/23/2006 and was last updated on 1/2/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332900000X	Non-Pharmacy Dispensing Site		40901020	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	32566400	MEDICAID	WISCONSIN
2	5127178	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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