Provider Demographics
NPI:1427717115
Name:ROCK RIVER COMMUNITY CLINIC INC
Entity type:Organization
Organization Name:ROCK RIVER COMMUNITY CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-472-6839
Mailing Address - Street 1:1461 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1568
Mailing Address - Country:US
Mailing Address - Phone:262-472-6839
Mailing Address - Fax:
Practice Address - Street 1:415 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-4730
Practice Address - Country:US
Practice Address - Phone:920-206-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCK RIVER COMMUNITY CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health