NPIMap

Organization Active NPI

Thedacare Medical Center - Wild Rose, Inc

  • Non-Pharmacy Dispensing Site
  • Wild Rose, WI
National Provider Identifier
1679095293
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
1004 Issued in WI
Legal business name
THEDACARE MEDICAL CENTER - WILD ROSE, INC
Practice address
601 Grove Ave
Wild Rose, WI 54984-6903
Phone
(920) 622-3257
Fax
(920) 622-6021
NPI assigned
Jul 14, 2017
Organization subpart
Yes
Parent organization
THEDACARE MEDICAL CENTER - WILD ROSE, INCAs reported in NPPES

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
Mr. William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 1004 WI Primary

Addresses

Primary practice location

601 Grove Ave
Wild Rose, WI 54984-6903

Mailing address

6501 City West Pkwy
Eden Prairie, MN 55344-3248
Phone (952) 653-2525

Other names 1

  • Wild Rose Community Memorial Hospital Inc Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Wild Rose Community Mem3 organizations share this tax ID, including this one
Part of
Wild Rose Community Mem

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1679095293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443248",
            "telephone_number": "952-653-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GROVE AVE",
            "city": "WILD ROSE",
            "state": "WI",
            "postal_code": "549846903",
            "telephone_number": "920-622-3257",
            "fax_number": "920-622-6021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - WILD ROSE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THEDACARE MEDICAL CENTER - WILD ROSE, INC",
        "enumeration_date": "2017-07-14",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "WI",
            "license": "1004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wild Rose Community Memorial Hospital Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wild Rose, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.