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NPI Code Detail

MEDICARE: WATERTOWN REGIONAL MEDICAL CENTER, INC

MEDICARE: WATERTOWN REGIONAL MEDICAL CENTER, INC
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
1251E00000XHome Health Agency165WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2A9OTHERWIDEAN CARE PROVIDER #
31020802OTHERWIPHY PLUS

General Provider Information

NPI Number : 1972505154
Entity Type Code : Organization
Provider Name (Legal Business Name) : WATERTOWN REGIONAL MEDICAL CENTER, INC
Provider Business Mailing Address
First Line : 125 HOSPITAL DR
Second Line :
City : WATERTOWN
State : WI
Zip : 53098-3303
Country : US
Telephone Number : 920-262-4784
Fax Number : 920-262-4640
Provider Business Practice Location Address
First Line : 125 HOSPITAL DR
Second Line :
City : WATERTOWN
State : WI
Zip : 53098-3303
Country : US
Telephone Number : 920-261-4210
Fax Number :
Authorized Official
Title or Position : DIRECTOR PATIENT ACCOUNTING
Name : MR. ROBERT JAMES KLUGE
Credential :
Telephone Number : 920-262-4784
Provider Enumeration Date : 06/01/2005
Last Update Date : 09/29/2011

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1205803947 — KATHLEEN M HARGARTEN MD
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1396712469 — JASON H LEE MD
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Practice Fax: 920-262-4360

Directions to “WATERTOWN REGIONAL MEDICAL CENTER, INC ” Practice Location

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