1801981279 NPI number — WATERTOWN UROLOGY, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801981279 NPI number — WATERTOWN UROLOGY, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATERTOWN UROLOGY, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801981279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 2002
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-261-1334
Provider Business Mailing Address Fax Number:
920-261-8755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 2002
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-261-1334
Provider Business Practice Location Address Fax Number:
920-261-8755
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOKOVICH
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
UROLOGIST
Authorized Official Telephone Number:
920-261-1334

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  32955-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023956 . This is a "PHYSICIANS PLUS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: DF8987 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 553251 . This is a "DEAN HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 21281700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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