Healthcare Provider Details

I. General information

NPI: 1538845805
Provider Name (Legal Business Name): EDGERTON HOSPITAL AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BURDICK ST
EDGERTON WI
53534-1729
US

IV. Provider business mailing address

11101 N SHERMAN RD
EDGERTON WI
53534-9002
US

V. Phone/Fax

Practice location:
  • Phone: 608-884-1609
  • Fax:
Mailing address:
  • Phone: 608-884-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ROEDER
Title or Position: CFO
Credential:
Phone: 608-884-3441