Provider Demographics
NPI:1063685071
Name:CITY OF WATERTOWN
Entity Type:Organization
Organization Name:CITY OF WATERTOWN
Other - Org Name:WATERTOWN DEPARTMENT OF PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:QUEST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-262-8090
Mailing Address - Street 1:515 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-4409
Mailing Address - Country:US
Mailing Address - Phone:920-262-8090
Mailing Address - Fax:
Practice Address - Street 1:515 S 1ST ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-4409
Practice Address - Country:US
Practice Address - Phone:920-262-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF WATERTOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44002500Medicaid
WI41855200Medicaid