Organization Name: | THEDACARE, INC |
NPI Number: | 1063569002 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GINA AUGUSTINE (MANAGER) |
Mailing Address: | 2809 N. Park Drive Lane Appleton |
State: | WI US |
Postal Code: | 54911 |
Phone Number: | 9203804999 |
Fax Number: | 9203804961 |
NPI Enumeration Date: | 01/04/2007 |
NPI Last Update Date: | 01/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |