ST GEORGE CLINICS LLC NPI 1194216416

NPI Information

  • NPI: 1194216416
  • Provider Name: ST GEORGE CLINICS, LLC
  • Classification: Clinic/Center - 261QM1300X
  • Specialization: Multi-Specialty
  • Entity Type: Organization
  • CLIA Number: 52D2151254
  • Address: 308 E MAIN ST
    WATERFORD, WI
    ZIP 53185
  • Phone: (262) 923-3777

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NPI Details

ST GEORGE CLINICS, LLC is a multi-specialty clinic center in Waterford, WI. ST GEORGE CLINICS, LLC NPI is 1194216416. The provider is registered as an organization entity type.

The provider's business location address is:

308 E MAIN ST
WATERFORD, WI
ZIP 53185-306
Phone: (262) 923-3777

The provider's authorized official is Tatjana Stevanovic .
The authorized official title is Adult Nurse Practioner and has the following contact phone number (262) 923-3777.

The CLIA number assigned to this NPI record is 52D2151254 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2018 and was last updated on 11/20/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM1300XClinic/CenterMulti-SpecialtyNo
2261QM1300XClinic/CenterMulti-Specialty52D1037628WISCONSINYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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