Organization
THEDACARE MEDICAL CENTER - WAUPACA, INC.
Active
Parent organization
THEDACARE MEDICAL CENTER - WAUPACA, INC.
Other names
RIVERSIDE MEDICAL CENTER, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
THEDACARE MEDICAL CENTER - WAUPACA, INC.
Authorized official
MR. MARK S THOMPSON (CFO)
(920) 830-5885
Entity
Organization
Contact information
Practice address
N2610 WI 22, WAUPACA, WI 54981
(715) 258-1021
Mailing address
PO BOX 2759, APPLETON, WI 54912-2759
(715) 258-1000
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
3031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
521334
MEDICARE PTAN
WI
Enumeration date
05/09/2016
Last updated
09/06/2019
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