MEDICARE: ROGERS MEMORIAL HOSPITAL, INC.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1699288142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGERS MEMORIAL HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	34700 VALLEY RD
Second Line	:
City	:	OCONOMOWOC
State	:	WI
Zip	:	53066-4500
Country	:	US
Telephone Number	:	800-767-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WINDING DR STE 106
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2907
Country	:	US
Telephone Number	:	800-767-4411
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	CINDY MEYER
Credential	:	MSSW
Telephone Number	:	262-303-0580

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	01/16/2026

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