Watertown Heart Institute SC

Primary specialty

SpecialistTaxonomy code 174400000X

License

36011-20 Issued in WI

Legal business name

WATERTOWN HEART INSTITUTE SC

Practice address

125 Hospital Drive
Watertown, WI 53098-3303

Phone

(920) 262-4449

Fax

(920) 262-4533

NPI assigned

Jan 20, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Salim M. Shammo, M.D.

Title

President

Phone

(414) 282-5105

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274400000000",
    "number": "1831420587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 LAYTON AVENUE",
            "address_2": "SUITE: 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215434",
            "telephone_number": "414-282-5105",
            "fax_number": "414-282-8670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DRIVE",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-262-4449",
            "fax_number": "920-262-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN HEART INSTITUTE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-20",
        "last_updated": "2010-05-21",
        "status": "A",
        "authorized_official_last_name": "SHAMMO",
        "authorized_official_first_name": "SALIM",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-282-5105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WI",
            "license": "36011-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32078400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Watertown Medical Center LLC

• Specialist in Watertown, WI
• Providers in Watertown, WI by specialty
• Specialist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.