Basic Information
| Provider Information | |||||||||
| NPI: | 1619345998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDGERTON HOSPITAL & HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11101 N SHERMAN RD | ||||||||
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| City: | EDGERTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535349002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088843441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11101 N SHERMAN RD | ||||||||
| Address2: | |||||||||
| City: | EDGERTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535349002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088843441 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCHULTZ | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6088843441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.