Provider Demographics
NPI:1760580286
Name:SOUTH SHORE ORTHOPEDICS
Entity Type:Organization
Organization Name:SOUTH SHORE ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS/BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-682-8189
Mailing Address - Street 1:2101 BEASER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3632
Mailing Address - Country:US
Mailing Address - Phone:715-682-8183
Mailing Address - Fax:715-682-8190
Practice Address - Street 1:2101 BEASER AVE STE 1
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3632
Practice Address - Country:US
Practice Address - Phone:715-682-8183
Practice Address - Fax:715-682-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32880200Medicaid
WI000004110OtherRAILROAD MEDICARE
WI71214OtherPEFERRED ONE I.D.
WI71214OtherPEFERRED ONE I.D.
WI32880200Medicaid
WI0596270001Medicare NSC
MI0N15450Medicare PIN