Provider Demographics
NPI:1710910476
Name:SURGICAL ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST CLINIC MGR/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KAYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2022
Mailing Address - Street 1:2400 PINE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7803
Mailing Address - Country:US
Mailing Address - Phone:715-847-2022
Mailing Address - Fax:715-847-2775
Practice Address - Street 1:2400 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7803
Practice Address - Country:US
Practice Address - Phone:715-847-2022
Practice Address - Fax:715-847-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39049Medicare ID - Type Unspecified