Provider Demographics
NPI:1043254162
Name:FVOSA SURGICAL PARTNERS, LLC
Entity Type:Organization
Organization Name:FVOSA SURGICAL PARTNERS, LLC
Other - Org Name:ORTHOPEDIC & SPORTS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF FVOSA
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KUPLIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-731-6611
Mailing Address - Street 1:2105 E. ENTERPRISE AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913
Mailing Address - Country:US
Mailing Address - Phone:920-560-1100
Mailing Address - Fax:920-560-1112
Practice Address - Street 1:2105 E. ENTERPRISE AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-560-1100
Practice Address - Fax:920-560-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical