Provider Demographics
NPI:1841387917
Name:TWIN CITY ORTHOPAEDIC CLINIC SC
Entity Type:Organization
Organization Name:TWIN CITY ORTHOPAEDIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-732-4040
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-0435
Mailing Address - Country:US
Mailing Address - Phone:715-732-4040
Mailing Address - Fax:715-732-2621
Practice Address - Street 1:2724 CAHILL RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3869
Practice Address - Country:US
Practice Address - Phone:715-732-4040
Practice Address - Fax:715-732-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0822320001Medicare NSC