Provider Demographics
NPI:1558348201
Name:ORTHOPEDIC ASSOCIATES OF SAUK PRAIRIE S.C.
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF SAUK PRAIRIE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-643-2471
Mailing Address - Street 1:35 PRAIRIE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1500
Mailing Address - Country:US
Mailing Address - Phone:608-643-2471
Mailing Address - Fax:608-643-4788
Practice Address - Street 1:35 PRAIRIE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1500
Practice Address - Country:US
Practice Address - Phone:608-643-2471
Practice Address - Fax:608-643-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32720300Medicaid
WI32720300Medicaid