Healthcare Provider Details

I. General information

NPI: 1053149674
Provider Name (Legal Business Name): ROGERS MEMORIAL HOSPITAL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 STATE ST
MANITOWOC WI
54220-4036
US

IV. Provider business mailing address

34700 VALLEY RD
OCONOMOWOC WI
53066-4599
US

V. Phone/Fax

Practice location:
  • Phone: 800-767-4411
  • Fax:
Mailing address:
  • Phone: 800-767-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CINDY A MEYER
Title or Position: PRESENT & CEO
Credential:
Phone: 262-303-0580