Provider Demographics
NPI:1699383703
Name:WEST ALLIS SURGERY CENTER LLC
Entity Type:Organization
Organization Name:WEST ALLIS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-296-0039
Mailing Address - Street 1:10150 W NATIONAL AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2153
Mailing Address - Country:US
Mailing Address - Phone:414-877-6412
Mailing Address - Fax:
Practice Address - Street 1:10150 W NATIONAL AVE STE 350
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2153
Practice Address - Country:US
Practice Address - Phone:414-296-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical