Provider Demographics
NPI:1477809978
Name:RIPON MEDICAL CENTER
Entity Type:Organization
Organization Name:RIPON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL MEDICINE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:920-748-9138
Mailing Address - Street 1:933 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1730
Mailing Address - Country:US
Mailing Address - Phone:920-748-9138
Mailing Address - Fax:920-748-0527
Practice Address - Street 1:933 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1730
Practice Address - Country:US
Practice Address - Phone:920-748-9138
Practice Address - Fax:920-748-0527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGNESIAN HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-02
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11991024282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11013210Medicaid