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THEDACARE MEDICAL CENTER - WILD ROSE INC NPI 1710018817


NPI Information

NPI: 1710018817
Provider Name: THEDACARE MEDICAL CENTER - WILD ROSE, INC

Doing Business As: WAUSHARA FAMILY PHYSICIANS

Classification: Non-Pharmacy Dispensing Site - 332900000X
Entity Type: Organization

CLIA Number: 52D0398014

Address:
701 GROVE AVE
WILD ROSE, WI
ZIP 54984
Phone: (920) 622-6013
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THEDACARE MEDICAL CENTER - WILD ROSE, INC is a non pharmacy dispensing site in Wild Rose, 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 MEDICAL CENTER - WILD ROSE, INC NPI is 1710018817. The provider is registered as an organization entity type.
The provider Is Doing Business As Waushara Family Physicians.

The provider's business location address is:

701 GROVE AVE
WILD ROSE, WI
ZIP 54984-901
Phone: (920) 622-6013
Fax: (920) 774-1026

The provider's authorized official is Jenifer Danzeisen .
The authorized official title is Clinic Manager/ Director Of Nu and has the following contact phone number (920) 622-5564.

The CLIA number assigned to this NPI record is 52D0398014 - hospital with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 3/8/2007 and was last updated on 7/31/2015.


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
1332900000XNon-Pharmacy Dispensing Site47322-20WISCONSINYes

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
12115407OTHERPK

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: 5/5/2024

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