Provider Demographics
NPI:1083323059
Name:ORTHOPEDIC & SPINE CENTERS OF WISCONSIN, SC.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE CENTERS OF WISCONSIN, SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SANSONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-333-1849
Mailing Address - Street 1:2501 W BELTLINE HWY STE 601
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 W BELTLINE HWY STE 601
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2309
Practice Address - Country:US
Practice Address - Phone:623-241-8730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty