Watertown Regional Medical Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WATERTOWN REGIONAL MEDICAL CENTER INC

Doing business as

UWHP WRMC Johnson Creek Clinic

Practice address

540 Village Walk LN
Johnson Creek, WI 53038-9554

Phone

(920) 699-6200

NPI assigned

Oct 26, 2007

Organization subpart

Yes

Parent organization

WATERTOWN REGIONAL MEDICAL CENTER INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert James Kluge

Title

Patient Accounts Manager

Phone

(920) 262-4784

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• UWHP WRMC Johnson Creek Clinic Doing business as

Part of

Watertown Medmorial HSP

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1043499080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 684088",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606954088",
            "telephone_number": "920-699-6200",
            "fax_number": "920-262-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 VILLAGE WALK LN",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530389554",
            "telephone_number": "920-699-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATERTOWN REGIONAL MEDICAL CENTER INC",
        "enumeration_date": "2007-10-26",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "KLUGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "920-262-4784",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21267000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UWHP WRMC Johnson Creek Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• University of Wisconsin Medical Foundation Inc
• Guillermo Miguel Valenzuela Cortez, MD
• Jenell Lynn Valenzuela, APNP
• Kim Vetuschi
• Village of Johnson Creek
• Watertown Regional Medical Center, Inc
• Lyndsey Webster, M.S. CCC-SLP
• Tory Lee Wetter, NP
• Ladd E. White, CSAC AND LPC

• Family Medicine Physician in Johnson Creek, WI
• Providers in Johnson Creek, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.