| Wild Rose Community Memorial Hospital Inc Dba Waushara Family Physicia | |
|
601 Grove Avenue Wild Rose WI 54984-0243 | |
| (920) 622-5560 | |
| Not Available |
| Full Name | Wild Rose Community Memorial Hospital Inc Dba Waushara Family Physicia |
|---|---|
| Speciality | Family Medicine |
| Location | 601 Grove Avenue, Wild Rose, Wisconsin |
| Authorized Official Name and Position | Donald Caves (PRESIDENT) |
| Authorized Official Contact | 9206225576 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Rose Community Memorial Hospital Inc Dba Waushara Family Physicia 701 Grove Ave Wild Rose WI 54984-0243 Ph: (920) 622-5560 | Wild Rose Community Memorial Hospital Inc Dba Waushara Family Physicia 601 Grove Avenue Wild Rose WI 54984-0243 Ph: (920) 622-5560 |
| NPI Number | 1720029804 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 03/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720029804 | NPI | - | NPPES |
| 32829100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |