Waupun Memorial Hospital

Key facts

NPI

1760460877

Entity type

Organization (NPI type 2)

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X

Legal business name

WAUPUN MEMORIAL HOSPITAL

Practice address

10 Beaver Dam St
Waupun, WI 53963-1869

Phone

(920) 324-5581

Fax

(920) 926-8885

NPI assigned

Jan 9, 2006

Organization subpart

No

Authorized official

Name

Steven N Little

Title

SVP & Cfo

Phone

(920) 926-5402

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Agnesian Healthcare Inc Durable Medical Equipment & Medical Supplies · Waupun, WI · NPI 1972879641
  NPD member Member Of
• SSM Health Care of Wisconsin Inc Certified Registered Nurse Anesthetist · Baraboo, WI · NPI 1336120401
  NPD member Member Of

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• SSM Health Dialysis Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 12, 2022.

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647043200000",
    "number": "1760460877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1283",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549361283",
            "telephone_number": "920-926-4472",
            "fax_number": "920-926-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BEAVER DAM ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631869",
            "telephone_number": "920-324-5581",
            "fax_number": "920-926-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUPUN MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SVP & CFO",
        "authorized_official_telephone_number": "920-926-5402"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI CHRONIC DISEASE PROGRA",
            "identifier": "42052700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN CARE",
            "identifier": "Z3",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42052700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waupun, WI

• Alannah L Wallsten, PHARMD
• Waupun Area School District
• Waupun Chiropractic Center, S.C.
• Waupun Memorial Hospital
• Waupun Memorial Hospital
• Trisha R West, DPT, LAT
• Janet Susan White
• Wound Care of Wisconsin LLC
• Dale A Wszalek
• Madeline Younger, OTR

All providers in Waupun, WI · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin