Wisconsin Eating Disorder Specialists SC

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

WISCONSIN EATING DISORDER SPECIALISTS SC

Practice address

34700 Valley Rd
Oconomowoc, WI 53066-4500

Phone

(262) 646-1387

Fax

(262) 646-7067

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Theodore Weltzin, MDNPI 1457343923

Title

Owner

Phone

(262) 646-4411

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theodore Eldon Weltzin, MD

  • Psychiatry Physician
  • Wauwatosa, WI
  • NPI 1457343923
  NPD (past) Authorized official

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801807375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 N HICKORY LN",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664532",
            "telephone_number": "262-646-1387",
            "fax_number": "262-646-7067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34700 VALLEY RD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664500",
            "telephone_number": "262-646-1387",
            "fax_number": "262-646-7067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN EATING DISORDER SPECIALISTS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WELTZIN",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-646-4411",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21282400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy G. Williamson, DDS
• Alyson Wilson
• Tiffany Lauren Wilson, HIS
• Thomas F Winters, MD
• Wisconsin Dental Group, S.C. (ForwardDental Oconomowoc)
• Wisconsin Endodontics SC (Endodontic Specialists of Wisconsin - Oconomowoc)
• Sharon Wittman, RD
• Jill P Wohlfeil, MD
• Brian T Wojczak
• Dereck Wolfgram, LCSW

• Psychiatric Hospital in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Psychiatric Hospital in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.