Thedacare Medical Center-Berlin Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

7733-42 Issued in WI

Legal business name

THEDACARE MEDICAL CENTER-BERLIN INC

Doing business as

ThedaCare Pharmacy - Wautoma

Practice address

N2934 Hwy 22 N
Wautoma, WI 54982-5267

Phone

(920) 787-5757

Fax

(920) 787-5382

NPI assigned

Dec 11, 2006

Last updated

Apr 18, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alissa Gies, PHARM DNPI 1134557051

Title

Pharmacist of Record

Phone

(920) 787-5757

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• ThedaCare Pharmacy - Wautoma Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alissa Gies, PHARMD

  • Pharmacist
  • Wautoma, WI
  • NPI 1134557051
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1184784159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N2934 HWY 22 N",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "54982",
            "telephone_number": "920-787-5757",
            "fax_number": "920-787-5382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2934 HWY 22 N",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549825267",
            "telephone_number": "920-787-5757",
            "fax_number": "920-787-5382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER-BERLIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "GIES",
        "authorized_official_first_name": "ALISSA",
        "authorized_official_title_or_position": "PHARMACIST OF RECORD",
        "authorized_official_telephone_number": "920-787-5757",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "7733-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33230600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2108771",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ThedaCare Pharmacy - Wautoma",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kriste Simonson
• Renee L Soroko, MS, LPC
• Darren D Stelter
• The Pines Treatment & Recovery Center
• Thedacare Medical Center - Berlin, Inc.
• Paul Francis Theyel, CICSW
• Sean A Tillery, PT
• Beth Rae Tornow, RDH
• Total Renal Care Inc (Wautoma Dialysis)
• Alyssa Anne Treu, PHARMD

• Community/Retail Pharmacy in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.