Provider Demographics
NPI:1154520195
Name:TAGGART, RUTH C (NP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:C
Last Name:TAGGART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BELOIT HEALTH SYSTEM INC.
Mailing Address - Street 2:1905 E. HUEBBE PARKWAY
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:BELOIT MEMORIAL HOSPITAL
Practice Address - Street 2:1969 W. HART ROAD
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2230
Practice Address - Country:US
Practice Address - Phone:608-363-5971
Practice Address - Fax:608-363-5737
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105339363LA2200X
IL209-018593363L00000X
IL209.018593363LA2200X
WI9116-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100086324Medicaid
CO28979826OtherMEDICAID PRACTICE NUMBER
CO98259733OtherMEDICAID PRACTICE NUMBER
CO33679533Medicaid
CO72721863OtherMEDICAID PRACTICE NUMBER
CO348308OtherMEDICARE GROUP NUMBER
CO810213OtherMEDICARE GROUP PTAN
CO33679533Medicaid