Provider Demographics
NPI:1518466143
Name:ORTHOPAEDIC SURGERY ASSOCIATES OF MARQUETTE PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGERY ASSOCIATES OF MARQUETTE PC
Other - Org Name:ADVANCED CENTER FOR ORTHOPEDICS AND PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOILANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-227-5624
Mailing Address - Street 1:841 W WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4139
Mailing Address - Country:US
Mailing Address - Phone:906-225-1321
Mailing Address - Fax:906-228-9371
Practice Address - Street 1:841 WEST WASHINGTON STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-1321
Practice Address - Fax:906-228-9371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier