THEDACARE MEDICAL CENTER - WAUPACA, INC. (NPI# 1992110399) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992110399 |
| Entity Type | Organization |
| Organization Name | THEDACARE MEDICAL CENTER - WAUPACA, INC. |
| Other Organization Name | RIVERSIDE MEDICAL CENTER, INC. |
| Practice Address |
800 Riverside Dr Waupaca WI 54981-1943 |
| Practice Telephone | 7152581000 |
| Practice Fax Number | 7152581626 |
| Mailing Telephone | 7152581000 |
| Mailing Fax Number | 7152581626 |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2015-07-10 |
| Authorized Official Name | MR. CRAIG ALAN KANTOS (CEO) |
| Authorized Official Telephone | 7152581000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | 1038 | WI | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 11018610 | 05 |
| Other Name | Type Code |
|---|---|
| Riverside Medical Center, Inc. | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710333893 | Thedacare Medical Center - Waupaca, Inc. | General Acute Care Hospital | N2610 Wi 22, Waupaca, WI 54981 | 2016-05-09 |
| 1063837557 | Thedacare Medical Center - Waupaca, Inc. | Non-Pharmacy Dispensing Site | 6501 City West Pkwy, Eden Prairie, MN 55344-3248 | 2014-02-20 |
| 1073799664 | Thedacare Medical Center - Waupaca, Inc. | General Acute Care Hospital | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2008-01-14 |
| 1780782680 | Thedacare Medical Center - Waupaca, Inc. | Nurse Anesthetist, Certified Registered | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2006-09-21 |
| 1831131796 | Thedacare Medical Center - Waupaca, Inc. | Medicare Defined Swing Bed Unit | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2006-06-12 |
| 1013995521 | Thedacare Medical Center - Waupaca, Inc. | General Acute Care Hospital | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2006-01-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | THEDACARE MEDICAL CENTER - WAUPACA, INC. | 800 Riverside Dr, Waupaca, WI 54981-1943 |
| Street Address |
800 RIVERSIDE DR |
| City | WAUPACA |
| State | WI |
| Zip Code | 54981-1943 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861475006 | Robert Ray Schrope Iv | Physician Assistant | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2005-11-22 |
| 1134726433 | Jason Bonfiglio | Physician Assistant | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2020-10-08 |
| 1528627239 | Jessica L Abraham | Physician Assistant | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2019-06-07 |
| 1942785712 | Daniel Haugly | Physical Therapist | 800 Riverside Dr, Waupaca, WI 54981 | 2018-09-27 |
| 1851884340 | Kimberley R Schneider | Physical Therapist | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2018-06-11 |
| 1376082628 | Jennifer Rose Draeger | Occupational Therapist | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2017-02-20 |
| 1609320555 | Adam Michael Irwin | Physical Therapist | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2016-08-09 |
| 1982055026 | Amanda Margaret Probasco | Physician Assistant | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2016-06-30 |
| 1801240858 | Jamie Lynn Schneider | Emergency Medicine | 800 Riverside Dr, Waupaca, WI 54981 | 2016-04-15 |
| 1558618595 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 800 Riverside Dr, Waupaca, WI 54981-1943 | 2012-08-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366096141 | Renee Elizabeth Winn | Speech-Language Pathologist | 800 Riverside Drive Dr. 902 Building, Speech Therapy, Waupaca, WI 54981 | 2019-07-30 |
| 1891263216 | Stephanie Rice | Dental Hygienist | N4008 Morgan Dr, Waupaca, WI 54981 | 2018-11-03 |
| 1972092989 | Renew Physical Therapy and Wellness, LLC | Physical Therapist | N2919 County Road Qq, Waupaca, WI 54981 | 2018-05-04 |
| 1366942195 | Lanna Boyle | Physical Medicine & Rehabilitation | E1132 Hillcrest Dr, Waupaca, WI 54981 | 2018-02-19 |
| 1710333893 | Thedacare Medical Center - Waupaca, Inc. | General Acute Care Hospital | N2610 Wi 22, Waupaca, WI 54981 | 2016-05-09 |
| 1750743365 | Kimberly Marie Kraeger | Counselor | Waupaca County Dhhs, 811 Harding St, Waupaca, WI 54981 | 2016-03-23 |
| 1619211596 | Kari Anna Esbensen | Counselor | N2919 Cty Qq, Waupaca, WI 54981 | 2012-11-16 |
| 1396027629 | Roots Wholistic Health | Chiropractor | 717 Churchill St., Waupaca, WI 54981 | 2011-09-13 |
| 1629387006 | Barton Jerome Blum | General Practice | E1803 Melody Lane, Waupaca, WI 54981 | 2010-10-01 |
| 1710219357 | Anne Marie Collins-reed | Social Worker | 315 River Road, New London, WI 54981 | 2010-02-08 |
| Find all providers in zip 54981 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
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| 1164938916 | Tai Diagnostics, Inc. | Clinical Medical Laboratory | 10101 W Innovation Dr Ste 600, Wauwatosa, WI 53226-4824 | 2017-12-15 |
| 1831619535 | Laboratory Corporation of America | Clinical Medical Laboratory | 1111 Delafield St Ste 301, Waukesha, WI 53188-3407 | 2017-06-23 |
| 1558896498 | Noah Associates Incorporated | Clinical Medical Laboratory | 10501 W Greenfield Ave, West Allis, WI 53214-2421 | 2017-04-28 |
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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.