THEDACARE MEDICAL CENTER - BERLIN, INC. (NPI# 1992159289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992159289 |
| Entity Type | Organization |
| Organization Name | THEDACARE MEDICAL CENTER - BERLIN, INC. |
| Other Organization Name | COMMUNITY HEALTH NETWORK, INC. AND BERLIN MEMORIAL HOSPITAL |
| Practice Address |
N2930 State Road 22 Wautoma WI 54982-5267 |
| Mailing Address |
Po Box 2759 Appleton WI 54912-2759 |
| Practice Telephone | 9203611313 |
| Mailing Telephone | 9208305900 |
| Mailing Fax Number | 9208305910 |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2019-09-18 |
| Authorized Official Name | MR. MARK S THOMPSON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9208305885 |
| Is Organization Subpart | Y |
| Parent Organization Name | THEDACARE MEDICAL CENTER - BERLIN, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
1060 | WI | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | MEDICARE PTAN | 521355 | 01 |
| Other Name | Type Code |
|---|---|
| COMMUNITY HEALTH NETWORK, INC. AND BERLIN MEMORIAL HOSPITAL | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023154929 | Thedacare Medical Center - Berlin, Inc. | Skilled Nursing Facility | 482 Oak St, Berlin, WI 54923-1204 | 2007-01-29 |
| 1447243399 | Thedacare Medical Center - Berlin, Inc. | Home Health | 402 Preston Lane, Redgranite, WI 54970 | 2005-08-25 |
| 1326493602 | Thedacare Medical Center - Berlin, Inc. | General Acute Care Hospital | 1080 W Fond Du Lac St, Ripon, WI 54971-9286 | 2016-04-25 |
| 1275943367 | Thedacare Medical Center - Berlin, Inc. | Anesthesiology | 225 Memorial Dr, Berlin, WI 54923-1243 | 2014-04-29 |
| 1760413777 | Thedacare Medical Center - Berlin, Inc. | General Acute Care Hospital | 225 Memorial Drive, Berlin, WI 54923-1243 | 2006-07-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | THEDACARE MEDICAL CENTER - BERLIN, INC. | 225 Memorial Dr, Berlin, WI 54923-1243 |
| Street Address |
N2930 STATE ROAD 22 |
| City | WAUTOMA |
| State | WI |
| Zip Code | 54982-5267 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205885712 | Heartland Ems, Inc. | Ambulance | N2930 State Road 22, Wautoma, WI 54982-5267 | 2006-05-10 |
| 1720465149 | Bailey L Wehrle | Specialist/Technologist | N2930 State Road 22, Wautoma, WI 54982-5267 | 2015-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780919506 | Virginia Ellen Moon | Counselor | 203 South 16th Court, Wautoma, WI 54982 | 2009-10-13 |
| 1528232832 | County of Waushara | Public Health or Welfare | 230 W. Park Street, Wautoma, WI 54982 | 2008-04-17 |
| 1770770125 | Waushara County Government | Case Management | 205 W Elm St, Wautoma, WI 54982 | 2007-10-01 |
| 1063606325 | Wautoma Area School District | Local Education Agency (LEA) | 556 S Cambridge St, Wautoma, WI 54982 | 2007-08-30 |
| 1013036433 | David J Brown | Dentist | 400 S Townline Road, Box 1440, Wautoma, WI 54982 | 2007-03-28 |
| 1285773820 | Chiroplus Complementary Healthcare Centers, LLC | Chiropractor | W7841 State Rd 21 &73, Wautoma, WI 54982 | 2007-02-06 |
| 1881767887 | Louis Francis Cooper | Psychologist | W7199 Chicago Road, Wautoma, WI 54982 | 2006-11-16 |
| 1902840069 | Ann E. Moore | Pharmacist | 900 E. Divison St, Aurora Pharmacy #300, Wautoma, WI 54982 | 2006-06-16 |
| 1790737443 | Waushara Industries, Inc. | Non-emergency Medical Transport (VAN) | 210 E Townline Rd, Wautoma, WI 54982 | 2006-05-17 |
| 1164414736 | Kim Ownby | Physician Assistant | N2934 Hwy 22 North, Wautoma, WI 54982 | 2005-08-18 |
| Find all providers in zip 54982 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710333893 | Thedacare Medical Center - Waupaca, Inc. | General Acute Care Hospital | N2610 Wi 22, Waupaca, WI 54981 | 2016-05-09 |
| 1255662573 | Donald Morris Levy | General Acute Care Hospital | 4348 W Tarrytown Ln, Mequon, WI 53092-4850 | 2010-01-26 |
| 1841483112 | Club Staffing | General Acute Care Hospital | 1082 Vinyard Dr, Oregon, WI 53575-3314 | 2007-08-21 |
| 1104953090 | New Anesthesia | General Acute Care Hospital | 1236 Stillmeadow Ln, Menasha, WI 54952-8920 | 2007-02-27 |
| 1184765240 | Tomah Memorial Hospital Inc | General Acute Care Hospital | 501 Gopher Dr, Tomah, WI 54660-4513 | 2007-02-10 |
| 1194737817 | Chippewa Valley Hospital & Oakview Care Center, Inc. | General Acute Care Hospital | 1220 3rd Ave W, Durand, WI 54736-1600 | 2006-08-12 |
| 1154350049 | Edgerton Hospital and Health Services | General Acute Care Hospital | 11101 N Sherman Rd, Edgerton, WI 53534-9002 | 2006-07-02 |
| 1881640183 | Westfields Hospital, Inc. | General Acute Care Hospital | 535 Hospital Road, New Richmond, WI 54017-1449 | 2006-05-26 |
| 1053362624 | Ripon Medical Center Inc | General Acute Care Hospital | 845 Parkside Street, Ripon, WI 54971-8505 | 2006-05-16 |
| 1255382933 | Cumberland Memorial Hospital | General Acute Care Hospital | 1110 7th Ave, Cumberland, WI 54829-9133 | 2006-05-15 |
| 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.