Watertown Family Practice Associates S.c. | |
127 Hospital Dr Watertown WI 53098-3303 | |
(920) 261-8500 | |
Not Available |
Full Name | Watertown Family Practice Associates S.c. |
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Speciality | Family Medicine |
Location | 127 Hospital Dr, Watertown, Wisconsin |
Authorized Official Name and Position | Michael E Sullivan (CLINIC PRESIDENT) |
Authorized Official Contact | 9202618500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Watertown Family Practice Associates S.c. 127 Hospital Dr Watertown WI 53098-3303 Ph: () - | Watertown Family Practice Associates S.c. 127 Hospital Dr Watertown WI 53098-3303 Ph: (920) 261-8500 |
NPI Number | 1811064942 |
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Provider Enumeration Date | 11/30/2006 |
Last Update Date | 04/07/2022 |
Medicare PECOS PAC ID | 4183608037 |
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Medicare Enrollment ID | O20040617000150 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811064942 | NPI | - | NPPES |
32687900 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Michael E Sullivan |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1093883142 PECOS PAC ID: 1153308887 Enrollment ID: I20040701000385 |
Provider Name | John R Basarich |
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Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1033178512 PECOS PAC ID: 3779542352 Enrollment ID: I20041008000306 |
Provider Name | Danielle G Tonelli |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1083806814 PECOS PAC ID: 5890889026 Enrollment ID: I20070919000665 |
Provider Name | Robert Legrow |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1013908771 PECOS PAC ID: 6406818657 Enrollment ID: I20090112000073 |
Provider Name | Andrea M Cantwell Durand |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396921375 PECOS PAC ID: 3678626892 Enrollment ID: I20090805000088 |
Provider Name | Bruce J Cochrane |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1922176064 PECOS PAC ID: 4789668633 Enrollment ID: I20110105001219 |
Provider Name | Leslie M Golden |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1336401736 PECOS PAC ID: 9739344094 Enrollment ID: I20150805006493 |
Provider Name | Jessica A Angove |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508234188 PECOS PAC ID: 6901115955 Enrollment ID: I20151014002245 |
Provider Name | Melodie J De Fouw |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1881164481 PECOS PAC ID: 3779824107 Enrollment ID: I20190411000551 |
Provider Name | Holly A Wallace |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124660592 PECOS PAC ID: 7214369735 Enrollment ID: I20191121000030 |
Provider Name | Carmen D Papenfuss |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699300137 PECOS PAC ID: 2163852989 Enrollment ID: I20200420000606 |
Provider Name | Ashley Ann Smaglick |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225770472 PECOS PAC ID: 0446647135 Enrollment ID: I20220427002540 |
Provider Name | Heidi Pauli |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912629908 PECOS PAC ID: 9739555889 Enrollment ID: I20221014002076 |
Provider Name | Anna Christa Stamas |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376172007 PECOS PAC ID: 1850712647 Enrollment ID: I20230720003681 |
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