Provider Demographics
NPI:1760420277
Name:HAND TO SHOULDER CENTER OF WISCONSIN, LTD.
Entity Type:Organization
Organization Name:HAND TO SHOULDER CENTER OF WISCONSIN, LTD.
Other - Org Name:HAND AND UPPER EXTREMITY CENTER OF NORTHEAST WISCONSIN, LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-730-8833
Mailing Address - Street 1:2323 N CASALOMA DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8284
Mailing Address - Country:US
Mailing Address - Phone:920-730-8833
Mailing Address - Fax:
Practice Address - Street 1:2323 N CASALOMA DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8284
Practice Address - Country:US
Practice Address - Phone:920-730-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIC01860OtherRAILROAD MEDICARE
WI32796600Medicaid
WI055586001OtherNATIONAL GOVERNMENT SERVI
WI32796600Medicaid