Provider Demographics
NPI:1407046436
Name:NORTHWOODS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTHWOODS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-563-0090
Mailing Address - Street 1:611 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568
Mailing Address - Country:US
Mailing Address - Phone:715-358-8600
Mailing Address - Fax:
Practice Address - Street 1:611 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568
Practice Address - Country:US
Practice Address - Phone:715-358-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
52C0001078Medicare Oscar/Certification