Provider Demographics
NPI:1083242325
Name:APPLETON SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:APPLETON SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-550-0188
Mailing Address - Street 1:5007 S HOWELL AVE # 125
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-6157
Mailing Address - Country:US
Mailing Address - Phone:314-550-0188
Mailing Address - Fax:
Practice Address - Street 1:1616 N CASALOMA DR # 200
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8245
Practice Address - Country:US
Practice Address - Phone:314-550-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical