Provider Demographics
NPI:1164056974
Name:ORTHOPEDIC SURGERY CENTER OF THE FOX VALLEY LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY CENTER OF THE FOX VALLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-965-9520
Mailing Address - Street 1:2223 LIME KILN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6213
Mailing Address - Country:US
Mailing Address - Phone:920-965-6382
Mailing Address - Fax:
Practice Address - Street 1:1205 W. AMERICAN DRIVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54596-5459
Practice Address - Country:US
Practice Address - Phone:920-965-6382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical