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 Lake Mills Clinic

Practice address

1025 Mulberry St
Lake Mills, WI 53551-1304

Phone

(920) 648-4518

NPI assigned

Oct 31, 2007

Last updated

Mar 19, 2014By the provider in NPPES

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

Director Patient Accounting

Phone

(920) 262-4784

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• UWHP WRMC Lake Mills Clinic Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Directions Counseling C

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1053590687",
    "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": "920-262-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MULBERRY ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511304",
            "telephone_number": "920-648-4518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATERTOWN REGIONAL MEDICAL CENTER INC",
        "enumeration_date": "2007-10-31",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "KLUGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR PATIENT ACCOUNTING",
        "authorized_official_telephone_number": "920-262-4784",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21266900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UWHP WRMC Lake Mills Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Lake Mills, WI
• Providers in Lake Mills, 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 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.