Provider Demographics
NPI:1558373977
Name:NORTHLAND ORTHOPEDIC ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:NORTHLAND ORTHOPEDIC ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:DYREBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-369-2300
Mailing Address - Street 1:444 E TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2852
Mailing Address - Country:US
Mailing Address - Phone:715-369-2300
Mailing Address - Fax:715-369-2482
Practice Address - Street 1:444 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2852
Practice Address - Country:US
Practice Address - Phone:715-369-2300
Practice Address - Fax:715-369-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207X00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43024500Medicaid
WI32339000Medicaid
WI42949500Medicaid
WI34101900Medicaid
WI30507700Medicaid
WI34097900Medicaid
WIG51428Medicare UPIN
WIS16179Medicare UPIN
WI34101900Medicaid
WI0708340001Medicare NSC
WIB52564Medicare UPIN
WI43024500Medicaid