Healthcare Provider Details

I. General information

NPI: 1821086034
Provider Name (Legal Business Name): WATERTOWN REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 HOSPITAL DR
WATERTOWN WI
53098-3334
US

IV. Provider business mailing address

129 HOSPITAL DR
WATERTOWN WI
53098-3334
US

V. Phone/Fax

Practice location:
  • Phone: 920-262-4800
  • Fax: 920-262-4813
Mailing address:
  • Phone: 920-262-4800
  • Fax: 920-262-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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