Provider Demographics
NPI:1609051176
Name:ANESTHESIA SERVICES OF NORTHERN WISCONSIN SC
Entity Type:Organization
Organization Name:ANESTHESIA SERVICES OF NORTHERN WISCONSIN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA-APNP
Authorized Official - Phone:715-356-7382
Mailing Address - Street 1:PO BOX 1697
Mailing Address - Street 2:611 VETERANS PARKWAY
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-1697
Mailing Address - Country:US
Mailing Address - Phone:715-356-7382
Mailing Address - Fax:
Practice Address - Street 1:611 VETERANS PARKWAY
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568
Practice Address - Country:US
Practice Address - Phone:715-356-7382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI580033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43791800Medicaid