Organization
WILD ROSE COMMUNITY MEMORIAL HOSPITAL INC DBA WAUSHARA FAMILY PHYSICIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD CAVES (PRESIDENT)
(920) 622-5576
Entity
Organization
Contact information
Practice address
601 GROVE AVENUE, WILD ROSE, WI 54984-0243
(920) 622-5560
Mailing address
701 GROVE AVE, WILD ROSE, WI 54984-0243
(920) 622-5560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32829100
—
WI
Enumeration date
06/09/2006
Last updated
03/18/2013
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