MEDICARE: EDGERTON HOSPITAL AND HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1487346557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGERTON HOSPITAL AND HEALTH SERVICES

Provider Business Mailing Address
First Line	:	11101 N SHERMAN RD
Second Line	:
City	:	EDGERTON
State	:	WI
Zip	:	53534-9002
Country	:	US
Telephone Number	:	608-884-3441
Fax Number	:	608-884-1609

Provider Business Practice Location Address
First Line	:	757 E MILWAUKEE ST
Second Line	:
City	:	WHITEWATER
State	:	WI
Zip	:	53190-2153
Country	:	US
Telephone Number	:	608-884-1609
Fax Number	:	608-884-1609

Authorized Official
Title or Position	:	CFO
Name	:	CHARLES ROEDER
Credential	:
Telephone Number	:	608-884-3441

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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Directions to “EDGERTON HOSPITAL AND HEALTH SERVICES ” Practice Location

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