Healthcare Provider Details

I. General information

NPI: 1962681593
Provider Name (Legal Business Name): WATERTOWN REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 HOSPITAL DR
WATERTOWN WI
53098-3304
US

IV. Provider business mailing address

PO BOX 684088
CHICAGO IL
60695-4088
US

V. Phone/Fax

Practice location:
  • Phone: 920-262-4825
  • Fax:
Mailing address:
  • Phone: 920-262-4784
  • Fax: 920-262-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. ROBERT JAMES KLUGE
Title or Position: DIRECTOR-PATIENT ACCOUNTING
Credential:
Phone: 920-262-4784