Provider Demographics
NPI:1801981279
Name:WATERTOWN UROLOGY, S.C.
Entity type:Organization
Organization Name:WATERTOWN UROLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SOKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:920-261-1334
Mailing Address - Street 1:123 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 2002
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098
Mailing Address - Country:US
Mailing Address - Phone:920-261-1334
Mailing Address - Fax:920-261-8755
Practice Address - Street 1:123 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 2002
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098
Practice Address - Country:US
Practice Address - Phone:920-261-1334
Practice Address - Fax:920-261-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32955-020208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1023956OtherPHYSICIANS PLUS
WIDF8987OtherRAILROAD MEDICARE
WI553251OtherDEAN HEALTH PLAN
WI21281700Medicaid