Organization
WAUPUN MEMORIAL HOSPITAL
Active
Other names
SSM Health Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN N LITTLE (SVP & CFO)
(920) 926-5402
Entity
Organization
Contact information
Practice address
10 BEAVER DAM ST, WAUPUN, WI 53963-1869
(920) 324-5581
(920) 926-8885
Mailing address
PO BOX 1283, FOND DU LAC, WI 54936-1283
(920) 926-4472
(920) 926-8885
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42052700
WI CHRONIC DISEASE PROGRA
WI
05
—
42052700
—
WI
01
—
Z3
DEAN CARE
WI
Enumeration date
01/09/2006
Last updated
03/12/2022
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