Provider Demographics
NPI:1366439515
Name:ASSOCIATED SURGICAL AND MEDICAL SPECIALISTS
Entity Type:Organization
Organization Name:ASSOCIATED SURGICAL AND MEDICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-325-4401
Mailing Address - Street 1:3111 W RAWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9417
Mailing Address - Country:US
Mailing Address - Phone:414-761-2600
Mailing Address - Fax:414-761-2620
Practice Address - Street 1:3111 W RAWSON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9417
Practice Address - Country:US
Practice Address - Phone:414-761-2600
Practice Address - Fax:414-761-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41913500Medicaid
WI52C00014056Medicare ID - Type UnspecifiedPROVIDER NUMBER