Active NPI
Watertown Regional Medical Center, Inc
Doing business as UWHP WRMC Bellissa Oconomowoc
- Plastic Surgery Physician
- Oconomowoc, WI
National Provider Identifier
1629346028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- Legal business name
- WATERTOWN REGIONAL MEDICAL CENTER, INC
- Doing business as
- UWHP WRMC Bellissa Oconomowoc
- Practice address
- W359N5002 Brown St
Suite 208
Oconomowoc, WI 53066-3366 - Phone
- (920) 262-4577
- Fax
- (920) 262-4578
- NPI assigned
- Dec 13, 2011
- Organization subpart
- Yes
- Parent organization
- WATERTOWN REGIONAL MEDICAL CENTER, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert James Kluge
- Title
- Director-Patient Accounting
- Phone
- (920) 262-4784
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | Primary |
Addresses
Primary practice location
W359N5002 Brown St
Suite 208
Oconomowoc, WI 53066-3366
Mailing address
PO Box 684088
Chicago, IL 60695-4088
Phone (920) 262-4784
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100021061 | Medicaid | WI |
Other names 1
- UWHP WRMC Bellissa Oconomowoc
National Provider Directory
National Provider Directory- Part of
- Watertown Medmorial HSP
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323734400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1395705600000",
"number": "1629346028",
"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": "920-262-4784",
"fax_number": "920-262-4640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W359N5002 BROWN ST",
"address_2": "SUITE 208",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530663366",
"telephone_number": "920-262-4577",
"fax_number": "920-262-4578"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WATERTOWN REGIONAL MEDICAL CENTER, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WATERTOWN REGIONAL MEDICAL CENTER, INC",
"enumeration_date": "2011-12-13",
"last_updated": "2014-03-25",
"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"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Plastic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100021061",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "UWHP WRMC Bellissa Oconomowoc",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Oconomowoc, WI
- Alyssa Walker, APNP
- Jessica Walos, PHD
- Kathleen Elizabeth Walsh
- Matthew W Waro, DC
- Allyson Waskosky, MSOT
- Watertown Regional Medical Center, Inc (UWHP WRMC One Wellness)
- Watertown Regional Medical Center, Inc (UWHP WRMC Oconomowoc Clinic)
- Amanda Watkins, MASTERS, SAC-IT
- Waukesha Health Care, Inc. (ProHealth Care Medical Associates)
- Waukesha Medical Services, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.