Organization
THEDACARE MEDICAL CENTER - BERLIN, INC.
Active
Other names
CHN Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK S THOMPSON (CHIEF FINANCIAL OFFICER)
(920) 830-5885
Entity
Organization
Contact information
Practice address
225 MEMORIAL DR, BERLIN, WI 54923-1243
(920) 361-5538
(920) 361-5499
Mailing address
PO BOX 2759, APPLETON, WI 54912-2759
(920) 830-5900
(920) 830-5910
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11011000
—
WI
Enumeration date
04/29/2014
Last updated
09/06/2019
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