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Thedacare Medical Center - Wild Rose, Inc
Non-Pharmacy Dispensing Site in Wild Rose, Wisconsin
NPI 1710018817

Thedacare Medical Center - Wild Rose, Inc is a Non-Pharmacy Dispensing Site based in Wild Rose, WI. Thedacare Medical Center - Wild Rose, Inc practices in Wild Rose, WI. The NPI Number for Thedacare Medical Center - Wild Rose, Inc is 1710018817 and holds a License No. 47322-20 (Wisconsin).

The current practice location address for Thedacare Medical Center - Wild Rose, Inc is 701 Grove Ave, Wild Rose, WI and can be reached out via phone at 920-622-6013 and via fax at 920-774-1026.

Location: 701 Grove Ave, Wild Rose, WI, 54984-0314
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1710018817
Provider Name
Thedacare Medical Center - Wild Rose, Inc
Credential
Provider Entity Type
Organization
Address
701 Grove Ave, Wild Rose, WI, 54984-0314
Phone Number
920-622-6013
Fax Number
920-774-1026
Provider Enumeration Date
03/08/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2115407 01 PK
institution
Provider Business Practice Location Address Details
Address
701 Grove Ave
City
Wild Rose
State
Wisconsin
Zip
54984-6901
Phone Number
920-622-6013
Fax Number
920-774-1026
person
Provider Business Mailing Address Details
Address
701 Grove Ave
City
Wild Rose
State
Wisconsin
Zip
54984-6901
Phone Number
920-622-6013
Fax Number
920-774-1026
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Non-Pharmacy Dispensing Site
Speciality
-
Taxonomy
332900000X
License No.
47322-20 (Wisconsin)
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
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