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General NPI Number Information
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NPI Number | 1013296391
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Entity Type | Organization
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Legal Business Name | WATERTOWN REGIONAL MEDICAL CENTER, INC
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 123 HOSPITAL DR STE 2004
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City | WATERTOWN
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State | WI
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Zip | 53098-3336
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Country | US
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Telephone | 920-262-4371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 684088
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City | CHICAGO
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State | IL
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Zip | 60695-4088
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Country | US
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Telephone | 920-262-4371
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Fax |
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Authorized Official
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Title or Position | DIRECTOR-PATIENT ACCOUNTING
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Name | ROBERT JAMES KLUGE
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Credential |
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Telephone | 920-262-4784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | WI
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