Provider Demographics
NPI:1144797614
Name:OVATION HAND INSTITUTE-WISCONSIN, SC.
Entity Type:Organization
Organization Name:OVATION HAND INSTITUTE-WISCONSIN, SC.
Other - Org Name:OVATION HAND INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:
Authorized Official - First Name:TARRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-432-1600
Mailing Address - Street 1:10532 N PORT WASHINGTON RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5563
Mailing Address - Country:US
Mailing Address - Phone:844-432-1600
Mailing Address - Fax:262-302-4075
Practice Address - Street 1:10532 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5563
Practice Address - Country:US
Practice Address - Phone:844-432-1600
Practice Address - Fax:920-915-9210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OVATION HAND INSTITUTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty