NPIMap

Organization Active NPI

Thedacare Medical Center - Waupaca, Inc.

  • Clinical Medical Laboratory
  • Waupaca, WI
National Provider Identifier
1992110399
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
1038 Issued in WI
Legal business name
THEDACARE MEDICAL CENTER - WAUPACA, INC.
Practice address
800 Riverside Dr
Waupaca, WI 54981-1943
Phone
(715) 258-1000
Fax
(715) 258-1626
NPI assigned
Jun 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 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
Clinical Medical Laboratory 291U00000X 1038 WI Primary

Addresses

Primary practice location

800 Riverside Dr
Waupaca, WI 54981-1943

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-8900

Other identifiers 1

IdentifierTypeStateIssuer
11018610MedicaidWI

Other names 1

  • Riverside Medical Center, Inc. Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0397986Thedacare Medical Center - Waupaca800 Riverside Dr, Waupaca, WI 54981AccreditationJan 2, 2027
52D2017050Thedacare Physicians Waupaca - Urology800 Riverside Dr, Waupaca, WI 54981Certificate of waiverJul 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
Steven M Sampson MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1403568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1992110399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-830-8900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811943",
            "telephone_number": "715-258-1000",
            "fax_number": "715-258-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - WAUPACA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-24",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": "1038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11018610",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Medical Center, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Waupaca, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.