Provider Demographics
NPI:1518999648
Name:CENTRAL WISCONSIN ANESTHESIOLOGY
Entity Type:Organization
Organization Name:CENTRAL WISCONSIN ANESTHESIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-845-5505
Mailing Address - Street 1:425 PINE RIDGE BOULEVARD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-845-5505
Mailing Address - Fax:715-848-2884
Practice Address - Street 1:425 PINE RIDGE BOULEVARD
Practice Address - Street 2:SUITE 211
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-845-5505
Practice Address - Fax:715-848-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43411800Medicaid
WI000039110OtherHUMANA GOLD MEDICARE
WI43411800OtherMANAGED HEALTH CARE
WIC01751OtherMEDICARE RAILROAD GROUP
WI000039110OtherSECURITY HEALTH ADVOCARE
WI43411800Medicaid
WI000039110Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WI43411800Medicaid