Thedcare Regional Medical Center - Neenah, Inc.

Organization Active NPI General Acute Care Hospital · Oshkosh, WI

NPI 1679937494 · NPPES record last updated Jan 2, 2024

Key facts

NPI
1679937494
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
License
32 (WI)
Legal business name
THEDCARE REGIONAL MEDICAL CENTER - NEENAH, INC.
Practice address
2400 Witzel Ave
Suite C
Oshkosh, WI 54904-8374
Phone
(920) 830-5900
Fax
(920) 830-5910
NPI assigned
Apr 7, 2016
Organization subpart
Yes
Parent organization (as reported)
THEDACARE REGIONAL MEDICAL CENTER - NEENAH, INC.

Authorized official

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

Owners & managing parties with NPI records 14

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 14

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

Affiliated clinicians 901

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 901

Medicare Care Compare: Hospital

Listed as
Thedacare Regional Med Ctr - Neenah CCN 520045
Overall star rating
★★★★☆ 4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Hospital certification: CCN 520045

Legal name
THEDACARE REGIONAL MEDICAL CENTER-NEENAH INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 12, 2010
Beds
182
Ownership / control type
Private (not for profit)
Organization structure
Corporation · Non-profit
Incorporated
Sep 23, 1909 in WI
Enrollment address
130 2ND St
Neenah, WI 54956-2883
Main/Primary Hospital Location
Hospital subgroups
General, Rehabilitation

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Froedtert Thedacare Health, Inc.
Organization · Milwaukee, WI
Corporation, Non-profit
Operational/Managerial Control Jan 1, 2024
Jennifer R Glasheen
Individual
W-2 Managing Employee
Payer Contracting
Jan 1, 2023
Laurie a Carter
Individual
Corporate Director
Board Member
Feb 1, 2022
Thedacare, Incorporated
Organization · Neenah, WI
Corporation, Non-profit
Operational/Managerial Control Jan 19, 2011
Mary W Goggans
Individual
Corporate Director
Board Member
Feb 1, 2022
Alan Loux
Individual
Corporate Director Jan 1, 2023
William Flett
Individual
Corporate Director
Cfo
Jan 1, 2024
W-2 Managing Employee
Cfo
Jan 1, 2024
Imran a Andrabi
Individual
Corporate Director
Ceo-President
Jun 28, 2017
W-2 Managing Employee
Ceo-President
Jun 28, 2017
Chuck Dallas
Individual
Corporate Director
Board Member
Feb 11, 2021
David W Koeper
Individual
Corporate Director
Board Member
Mar 1, 2022
Susan M Pahl
Individual
W-2 Managing Employee Jan 1, 2022
Steven J Price
Individual
Corporate Director Jan 1, 2023
Kathleen Pigeon
Individual
W-2 Managing Employee
Provider Enrollment
Jun 11, 2020
Michael Morse
Individual
Corporate Director
Board Member
Jan 1, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20081006000715 WI Part a Provider - Hospital 8921090846 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Menasha, WI; Neenah, WI; Oshkosh, WI

National Provider Directory

Tax ID family
Thedacare Regional Medical (15 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 32 WI Yes

Addresses

Primary practice location

2400 Witzel Ave
Suite C
Oshkosh, WI 54904-8374

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other identifiers

IdentifierTypeStateIssuer
520045OtherWIMEDICARE PTAN

Other names

  • THEDA CLARK MEDICAL CENTER, INC. Former legal business name

Other providers in Oshkosh, WI

All providers in Oshkosh, WI · General Acute Care Hospital in Wisconsin

Sources for this page

Verify at the official NPI Registry.