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Organization Active NPI

Watertown Memorial Hospital Association Inc

Doing business as Watertown Mem Hospital Phy Op

  • Institutional Pharmacy
  • Watertown, WI
National Provider Identifier
1679632996
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
5450 Issued in WI
Legal business name
WATERTOWN MEMORIAL HOSPITAL ASSOCIATION INC
Doing business as
Watertown Mem Hospital Phy Op
Practice address
125 Hospital Dr
Watertown, WI 53098-3303
Phone
(920) 262-4393
Fax
(920) 262-4607
NPI assigned
Dec 6, 2006
Last updated
May 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2010

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

Authorized official

Name
John Schloemer
Title
Pharmacy Manager
Phone
(920) 262-4393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X 5450 WI Primary

Addresses

Primary practice location

125 Hospital Dr
Watertown, WI 53098-3303

Mailing address

125 Hospital Dr
Watertown, WI 53098-3303
Phone (920) 262-4393

Other identifiers 2

IdentifierTypeStateIssuer
5123928OtherNCPDP PROVIDER IDENTIFICATION NUMBER
11015400MedicaidWI

Other names 1

  • WATERTOWN MEM HOSPITAL PHY OP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Directions Counseling C4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1679632996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-262-4393",
            "fax_number": "920-262-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-262-4393",
            "fax_number": "920-262-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN MEMORIAL HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "SCHLOEMER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "920-262-4393"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "WI",
            "license": "5450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5123928",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11015400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WATERTOWN MEM HOSPITAL PHY OP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watertown, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; 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.