Provider Demographics
NPI:1740278456
Name:COUNTY OF ROCK COUNTY CLERK
Entity type:Organization
Organization Name:COUNTY OF ROCK COUNTY CLERK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUDMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-757-5151
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53547-0351
Mailing Address - Country:US
Mailing Address - Phone:608-757-5000
Mailing Address - Fax:608-757-5010
Practice Address - Street 1:3418 N COUNTY HWY F
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545
Practice Address - Country:US
Practice Address - Phone:608-757-5000
Practice Address - Fax:608-757-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2425314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20161800Medicaid
WI600000111OtherMEDICARE RAILROAD
WI=========OtherTAX ID#
WI20161800Medicaid