Provider Demographics
NPI:1447424718
Name:MINOR PROCEDURES, S.C.
Entity Type:Organization
Organization Name:MINOR PROCEDURES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-251-6060
Mailing Address - Street 1:1920 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2027
Mailing Address - Country:US
Mailing Address - Phone:608-251-6060
Mailing Address - Fax:608-251-3930
Practice Address - Street 1:1920 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2027
Practice Address - Country:US
Practice Address - Phone:608-251-6060
Practice Address - Fax:608-251-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35780-020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32182800Medicaid
WI000015505Medicare PIN
WI32182800Medicaid