Provider Demographics
NPI:1508936642
Name:SHEBOYGAN ORTHOPAEDIC ASSOCIATES SC
Entity Type:Organization
Organization Name:SHEBOYGAN ORTHOPAEDIC ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OFFICER 5 PER OR MORE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-458-3791
Mailing Address - Street 1:2920 SUPERIOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-458-3791
Mailing Address - Fax:920-458-3783
Practice Address - Street 1:2920 SUPERIOR AVENUE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-458-3791
Practice Address - Fax:920-458-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32750800Medicaid
WI32750800Medicaid
WI0589550001Medicare NSC