Provider Demographics
NPI:1619231263
Name:PAUSTIAN MEDICAL & SURGICAL CENTER, S. C.
Entity Type:Organization
Organization Name:PAUSTIAN MEDICAL & SURGICAL CENTER, S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:PAUSTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:715-743-2483
Mailing Address - Street 1:W3657 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-6065
Mailing Address - Country:US
Mailing Address - Phone:715-743-2483
Mailing Address - Fax:715-743-7956
Practice Address - Street 1:W3657 MAPLE RD
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-6065
Practice Address - Country:US
Practice Address - Phone:715-743-2483
Practice Address - Fax:715-743-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42083-21208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty