Organization
WAUPUN MEMORIAL HOSPITAL
Active
Parent organization
WAUPUN MEMORIAL HOSPITAL
Other names
SSM Health Dialysis Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAUPUN MEMORIAL HOSPITAL
Authorized official
TROY WALKER (DIRECTOR OF FINANCE)
(608) 356-1423
Entity
Organization
Contact information
Practice address
110 MONROE ST, BEAVER DAM, WI 53916-2437
(920) 887-3376
(920) 887-3532
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
—
42059500
WI CHRONIC DISEASE PROGRA
WI
05
—
42059500
—
WI
01
—
567318
DEAN CARE
WI
Enumeration date
01/06/2006
Last updated
04/20/2022
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