Provider Demographics
NPI:1518993880
Name:THEDACARE REGIONAL MEDICAL CENTER-NEENAH, INC.
Entity Type:Organization
Organization Name:THEDACARE REGIONAL MEDICAL CENTER-NEENAH, INC.
Other - Org Name:THEDA CLARK MEDICAL CENTER INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-454-4013
Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-830-5950
Mailing Address - Fax:920-830-5910
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-729-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THEDACARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-25
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI520045OtherMEDICARE PTAN-PART A/B PROVIDER NUMBER
WI41318800Medicaid
WI52T045OtherMEDICARE PTAN-IP REHAB BEDS AT TCRMC-NEENAH
WI000092455OtherMEDICARE PTAN-INDEPENDENT MRI PART B
WI32944400Medicaid
WI11009900Medicaid
WI32944400Medicaid
WI520045Medicare Oscar/Certification
WI52T045Medicare Oscar/Certification
WI000000227Medicare PIN