Provider Demographics
NPI:1639494321
Name:RIPON MEDICAL CENTER
Entity Type:Organization
Organization Name:RIPON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-748-9190
Mailing Address - Street 1:680 E FOND DU LAC ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-9500
Mailing Address - Country:US
Mailing Address - Phone:920-748-3009
Mailing Address - Fax:
Practice Address - Street 1:680 E FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9500
Practice Address - Country:US
Practice Address - Phone:920-748-3009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIPON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-06
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6441100003Medicare NSC