| Organization Name: | THEDACARE MEDICAL CENTER - NEW LONDON, INC. |
| NPI Number: | 1144675745 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIM A OLSON (CFO) |
| Mailing Address: | 370 S Main St Clintonville |
| State: | WI US |
| Postal Code: | 549291632 |
| Phone Number: | 9208305900 |
| Fax Number: | 9208305910 |
| NPI Enumeration Date: | 05/02/2016 |
| NPI Last Update Date: | 05/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | 1029 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |