MEDICARE: COUNTY OF ROCK COUNTY CLERK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	2425	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	600000111	OTHER	WI	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740278456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF ROCK COUNTY CLERK

Provider Business Mailing Address
First Line	:	PO BOX 351
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53547-0351
Country	:	US
Telephone Number	:	608-757-5000
Fax Number	:	608-757-5010

Provider Business Practice Location Address
First Line	:	3418 N COUNTY HWY F
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545
Country	:	US
Telephone Number	:	608-757-5000
Fax Number	:	608-757-5010

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. DAVID R SUDMEIER
Credential	:
Telephone Number	:	608-757-5151

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	06/21/2018

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Directions to “COUNTY OF ROCK COUNTY CLERK ” Practice Location

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