Provider Demographics
NPI:1659699023
Name:WATERTOWN REGIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:WATERTOWN REGIONAL MEDICAL CENTER, INC
Other - Org Name:UWHP WRMC ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PATIENT ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KLUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-262-4784
Mailing Address - Street 1:123 HOSPITAL DR
Mailing Address - Street 2:STE 1008
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3320
Mailing Address - Country:US
Mailing Address - Phone:920-262-4784
Mailing Address - Fax:920-262-4640
Practice Address - Street 1:123 HOSPITAL DR
Practice Address - Street 2:SUITE 1008
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3320
Practice Address - Country:US
Practice Address - Phone:920-206-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WATERTOWN REGIONAL MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-11
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100009329Medicaid
WI100009329Medicaid