| St George Clinics, Llc | |
|
308 E Main St Waterford WI 53185-4306 | |
| (262) 923-3777 | |
| Not Available |
| Full Name | St George Clinics, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 308 E Main St, Waterford, Wisconsin |
| Authorized Official Name and Position | Tatjana Stevanovic (ADULT NURSE PRACTIONER) |
| Authorized Official Contact | 2629233777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St George Clinics, Llc 308 E Main St Waterford WI 53185-4306 Ph: (262) 923-3777 | St George Clinics, Llc 308 E Main St Waterford WI 53185-4306 Ph: (262) 923-3777 |
| NPI Number | 1194216416 |
|---|---|
| Provider Enumeration Date | 05/22/2018 |
| Last Update Date | 11/20/2023 |
| Medicare PECOS PAC ID | 2264873876 |
|---|---|
| Medicare Enrollment ID | O20240514003020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194216416 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 52D1037628 (Wisconsin) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Tatjana Stevanovic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366503864 PECOS PAC ID: 3173964780 Enrollment ID: I20240514003094 |
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