THEDACARE MEDICAL CENTER - SHAWANO, INC. (NPI# 1548260839) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548260839 |
| Entity Type | Organization |
| Organization Name | THEDACARE MEDICAL CENTER - SHAWANO, INC. |
| Other Organization Name | SHAWANO MEDICAL CENTER, INC. |
| Practice Address |
100 County Road B Shawano WI 54166-7072 |
| Mailing Address |
Po Box 2759 Appleton WI 54912-2759 |
| Practice Telephone | 7155262111 |
| Practice Fax Number | 7155267308 |
| Mailing Telephone | 9208305900 |
| Mailing Fax Number | 9208305910 |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-09-06 |
| Authorized Official Name | MR. MARK S THOMPSON (CFO) |
| Authorized Official Telephone | 9208305885 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
1051 | WI | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 11013410 | 05 | |
| WI | 41173800 | 05 | |
| WI | 32762800 | 05 | |
| WI | 11013400 | 05 | |
| WI | 32944300 | 05 |
| Other Name | Type Code |
|---|---|
| SHAWANO MEDICAL CENTER, INC. | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801447925 | Thedacare Medical Center - Shawano, Inc. | Clinic/Center | 370 S Main St, Clintonville, WI 54929-1632 | 2019-09-20 |
| 1649821760 | Thedacare Medical Center - Shawano, Inc. | Clinic/Center | 100 County Road B, Shawano, WI 54166-7072 | 2019-09-20 |
| 1720493125 | Thedacare Medical Center - Shawano, Inc. | Clinical Medical Laboratory | 100 County Road B, Shawano, WI 54166-7072 | 2014-06-24 |
| 1710206636 | Thedacare Medical Center - Shawano, Inc. | Non-Pharmacy Dispensing Site | 6501 City West Pkwy, Eden Prairie, MN 55344-3248 | 2010-05-18 |
| 1265618979 | Thedacare Medical Center - Shawano, Inc. | Medicare Defined Swing Bed Unit | 100 County Road B, Shawano, WI 54166-7072 | 2008-01-11 |
| Street Address |
100 COUNTY ROAD B |
| City | SHAWANO |
| State | WI |
| Zip Code | 54166-7072 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053929653 | Jenna J Mulder | Student in an Organized Health Care Education/Training Program | 100 County Road B, Shawano, WI 54166-7072 | 2020-07-20 |
| 1730704420 | Katherine Dewane | Registered Nurse | 100 County Road B, Shawano, WI 54166-7072 | 2020-06-09 |
| 1063046761 | Amanda Nicole Walbrun | Physician Assistant | 100 County Road B, Shawano, WI 54166-7072 | 2020-03-03 |
| 1952932972 | Kerry L Baird | Registered Nurse | 100 County Road B, Shawano, WI 54166-7072 | 2020-01-29 |
| 1417599804 | Calla J Scheel | Registered Nurse | 100 County Road B, Shawano, WI 54166-7072 | 2019-10-17 |
| 1649821760 | Thedacare Medical Center - Shawano, Inc. | Clinic/Center | 100 County Road B, Shawano, WI 54166-7072 | 2019-09-20 |
| 1477100477 | Cynthia M Bohringer | Registered Nurse | 100 County Road B, Shawano, WI 54166-7072 | 2019-08-23 |
| 1619523115 | Heather Kristine Elertson | Registered Nurse | 100 County Road B, Shawano, WI 54166-7072 | 2019-08-12 |
| 1164084760 | Matthew James Osborne | Physical Therapist | 100 County Road B, Shawano, WI 54166-7072 | 2019-07-03 |
| 1548744162 | Casey M Carroll | Speech-Language Pathologist | 100 County Road B, Shawano, WI 54166-7072 | 2018-09-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134641848 | Nicole Jeannine Klotzbuecher | Optometrist | 150 County Road B, Shawano, WI 54166 | 2017-07-13 |
| 1437605714 | Jennifer Marie Franke | Counselor | 504 Lakeland St, Shawano, WI 54166 | 2016-08-28 |
| 1699017913 | Benjamin D Schlais | Family Medicine | 100 County Hwy B, Shawano, WI 54166 | 2013-03-25 |
| 1154574366 | Luke T Johnson | Speech-Language Pathologist | N3684 River Road, Shawano, WI 54166 | 2008-10-31 |
| 1902054315 | Robert Joseph Bohr Jr. | Physical Therapy Assistant | N6590 Fox Lane, Shawano, WI 54166 | 2008-08-28 |
| 1790945863 | Patricia Rae Ainsworth | Physical Therapist | 1436 South Lincoln Street, Shawano, WI 54166 | 2008-06-12 |
| 1649491820 | Shawano-gresham School District | Local Education Agency (LEA) | 1050 South Union Street, Shawano, WI 54166 | 2007-05-02 |
| 1114043387 | Thomas G Peterson | Optometrist | 150a County Road B, Shawano, WI 54166 | 2007-03-21 |
| 1740343086 | John Milton Dovorany | Dentist | 1488 E Green Bay St, Shawano, WI 54166 | 2006-12-18 |
| 1265526305 | Charles E Lamarche | Counselor | 420 E Green Bay St, Ste 201, Shawano, WI 54166 | 2006-10-03 |
| Find all providers in zip 54166 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1710333893 | Thedacare Medical Center - Waupaca, Inc. | General Acute Care Hospital | N2610 Wi 22, Waupaca, WI 54981 | 2016-05-09 |
| 1255662573 | Donald Morris Levy | General Acute Care Hospital | 4348 W Tarrytown Ln, Mequon, WI 53092-4850 | 2010-01-26 |
| 1841483112 | Club Staffing | General Acute Care Hospital | 1082 Vinyard Dr, Oregon, WI 53575-3314 | 2007-08-21 |
| 1104953090 | New Anesthesia | General Acute Care Hospital | 1236 Stillmeadow Ln, Menasha, WI 54952-8920 | 2007-02-27 |
| 1184765240 | Tomah Memorial Hospital Inc | General Acute Care Hospital | 501 Gopher Dr, Tomah, WI 54660-4513 | 2007-02-10 |
| 1194737817 | Chippewa Valley Hospital & Oakview Care Center, Inc. | General Acute Care Hospital | 1220 3rd Ave W, Durand, WI 54736-1600 | 2006-08-12 |
| 1154350049 | Edgerton Hospital and Health Services | General Acute Care Hospital | 11101 N Sherman Rd, Edgerton, WI 53534-9002 | 2006-07-02 |
| 1881640183 | Westfields Hospital, Inc. | General Acute Care Hospital | 535 Hospital Road, New Richmond, WI 54017-1449 | 2006-05-26 |
| 1053362624 | Ripon Medical Center Inc | General Acute Care Hospital | 845 Parkside Street, Ripon, WI 54971-8505 | 2006-05-16 |
| 1255382933 | Cumberland Memorial Hospital | General Acute Care Hospital | 1110 7th Ave, Cumberland, WI 54829-9133 | 2006-05-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.