NPIMap

Organization Active NPI

Thedacare Medical Center - Shawano, Inc.

Doing business as ThedaCare Apothecary-Shawano

  • Community/Retail Pharmacy
  • Shawano, WI
National Provider Identifier
1306516604
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
THEDACARE MEDICAL CENTER - SHAWANO, INC.
Doing business as
ThedaCare Apothecary-Shawano
Practice address
100 County Road B
Shawano, WI 54166-7072
Phone
(715) 526-7300
Fax
(920) 993-5031
NPI assigned
Sep 17, 2021
Last updated
Jan 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Authorized official

Name
William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

100 County Road B
Shawano, WI 54166-7072

Mailing address

100 County Road B
Shawano, WI 54166-7072
Phone (715) 526-7300

Other names 1

  • ThedaCare Apothecary-Shawano Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211022000413 WI Part B Supplier - Pharmacy 5890605836 Practice locations: Shawano, WI
O20220620000734 WI DME Supplier - Pharmacy 5890605836 Practice locations: Shawano, WI

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shawano Community Hosp6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 168

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.

View all 168

NPI Registry JSON

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1306516604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-526-7300",
            "fax_number": "920-993-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-526-7300",
            "fax_number": "920-993-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - SHAWANO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ThedaCare Apothecary-Shawano",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ThedaCare Apothecary-Shawano",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.