Provider Demographics
NPI:1992756282
Name:CITY OF WATERTOWN
Entity type:Organization
Organization Name:CITY OF WATERTOWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-261-3610
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-0477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 JONES ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3737
Practice Address - Country:US
Practice Address - Phone:262-261-3610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ935059Medicaid
41336500OtherMANAGED HEALTH MAHMO
WI41336500Medicaid
WI0101OtherJOHN DEERE
IA0980581OtherMEDICAL ASSOCIATES HMO
WI41336500OtherHIRSP
MN008225200Medicaid
1012124OtherPHYSICIAN'S PLUS
8181954OtherMEDICA
000085338OtherADVOCARE MCHMO
35283OtherNETWORK HEALTH
35283OtherNETWORK HEALTH
=========018OtherBCBS
=========018OtherVALLEY HEALTH PLAN
WI0101OtherJOHN DEERE
8181954OtherMEDICA
=========OtherDEAN HEALTH PLAN
AZ935059Medicaid