THEDACARE MEDICAL CENTER - SHAWANO, INC. (NPI# 1649821760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649821760 |
| Entity Type | Organization |
| Organization Name | THEDACARE MEDICAL CENTER - SHAWANO, INC. |
| Practice Address |
100 County Road B Shawano WI 54166-7072 |
| Mailing Address |
122 E College Ave Appleton WI 54911-5794 |
| Practice Telephone | 7155242161 |
| Practice Fax Number | 7155248164 |
| Mailing Telephone | 9209963264 |
| Mailing Fax Number | 9208305910 |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2019-09-20 |
| Authorized Official Name | MARK STEVEN THOMPSON (CFO) |
| Authorized Official Telephone | 9208305885 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548260839 | Thedacare Medical Center - Shawano, Inc. | General Acute Care Hospital | 100 County Road B, Shawano, WI 54166-7072 | 2005-07-28 |
| 1801447925 | Thedacare Medical Center - Shawano, Inc. | Clinic/Center | 370 S Main St, Clintonville, WI 54929-1632 | 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 |
|---|---|---|---|---|
| 1548260839 | Thedacare Medical Center - Shawano, Inc. | General Acute Care Hospital | 100 County Road B, Shawano, WI 54166-7072 | 2005-07-28 |
| 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 |
| 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 | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1366878449 | Amery Regional Medical Center, Inc | Clinic/Center | 357 Third Ave, Clear Lake, WI 54005-0177 | 2013-09-19 |
| 1851652374 | St. Croix Regional Medical Center | Clinic/Center | 26425 Lakeland Avenue South, Webster, WI 54893-8341 | 2012-05-31 |
| 1811256126 | St. Croix Regional Medical Center | Clinic/Center | 205 West Oak Street, Frederic, WI 54837 | 2012-05-07 |
| 1508198961 | Door County Memorial Hospital | Clinic/Center | 3711 Highway 42, Fish Creek, WI 54212 | 2010-02-09 |
| 1174627483 | Door County Memorial Hospital | Clinic/Center | 910 Main Rd, Washington Island, WI 54246 | 2006-09-08 |
| 1881607463 | St. Joseph's Health Services, Inc | Clinic/Center | 301 Railroad Rd, Wonewoc, WI 53968-9425 | 2006-08-14 |
| Find all providers with the same taxonomy | ||||
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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.