St George Clinics, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

52D1037628 Issued in WI

Legal business name

ST GEORGE CLINICS, LLC

Practice address

308 E Main St
Waterford, WI 53185-4306

Phone

(262) 923-3777

NPI assigned

May 22, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Tatjana Stevanovic, NP

Title

Adult Nurse Practioner

Phone

(262) 923-3777

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1194216416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 E MAIN ST",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531854306",
            "telephone_number": "262-923-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 E MAIN ST",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531854306",
            "telephone_number": "262-923-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST GEORGE CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "STEVANOVIC",
        "authorized_official_first_name": "TATJANA",
        "authorized_official_title_or_position": "ADULT NURSE PRACTIONER",
        "authorized_official_telephone_number": "262-923-3777",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WI",
            "license": "52D1037628",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Charles Smith, LPC, CSAC
• Jaia Sojka
• Cynthia D Sorenson, PHD
• Callie Spaulding
• Alok K Srivastava, MD
• Jill Elizabeth Stobber, LAT, A.T.,C.
• Claran Stovich
• Jenna Straszheim, MS, SLP-CF
• Linda M Stroede, OTR
• Coleen Swan, SOCIAL WORKER

• Multi-Specialty Clinic/Center in Waterford, WI
• Providers in Waterford, WI by specialty
• Multi-Specialty Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.