Provider Demographics
NPI:1568620995
Name:WHITEWATER VETERINARY HOSPITAL SC
Entity Type:Organization
Organization Name:WHITEWATER VETERINARY HOSPITAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVORSON
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:262-473-2930
Mailing Address - Street 1:527 S JANESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1719
Mailing Address - Country:US
Mailing Address - Phone:262-473-2930
Mailing Address - Fax:
Practice Address - Street 1:527 S JANESVILLE ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1719
Practice Address - Country:US
Practice Address - Phone:262-473-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116975-VC174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174M00000XOther Service ProvidersVeterinarianGroup - Single Specialty