Provider Demographics
NPI:1225058514
Name:SURGICAL ASSOCIATES OF WISCONSIN RAPIDS SC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF WISCONSIN RAPIDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-422-7771
Mailing Address - Street 1:420 DEWEY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4714
Mailing Address - Country:US
Mailing Address - Phone:715-422-7771
Mailing Address - Fax:715-424-4404
Practice Address - Street 1:420 DEWEY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4714
Practice Address - Country:US
Practice Address - Phone:715-422-7771
Practice Address - Fax:715-424-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21294100Medicaid
WI=========012OtherBCBS
WI000072050Medicare ID - Type Unspecified