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General NPI Number Information
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NPI Number | 1427717115
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Entity Type | Organization
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Legal Business Name | ROCK RIVER COMMUNITY CLINIC INC
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 132 HOSPITAL DR
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City | WATERTOWN
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State | WI
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Zip | 53098-3304
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Country | US
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Telephone | 920-206-7797
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Fax | 920-206-0870
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Provider Business Mailing Address
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Address Line | 1461 W MAIN ST
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City | WHITEWATER
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State | WI
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Zip | 53190-1568
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Country | US
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Telephone | 262-472-6839
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Fax |
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | OLIVIA NICHOLS
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Credential | PHD
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Telephone | 262-472-6839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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