Provider Demographics
NPI: | 1851356786 |
---|---|
Name: | WAUSAU SURGERY CENTER LLC |
Entity Type: | Organization |
Organization Name: | WAUSAU SURGERY CENTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CARMEL |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | GALSTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 715-842-4490 |
Mailing Address - Street 1: | 3801 STEWART AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | WAUSAU |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 54401-3961 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 715-842-4490 |
Mailing Address - Fax: | 715-842-4645 |
Practice Address - Street 1: | 3801 STEWART AVE |
Practice Address - Street 2: | |
Practice Address - City: | WAUSAU |
Practice Address - State: | WI |
Practice Address - Zip Code: | 54401-3961 |
Practice Address - Country: | US |
Practice Address - Phone: | 715-842-4490 |
Practice Address - Fax: | 715-842-4645 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-04-20 |
Last Update Date: | 2022-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 41907700 | Medicaid |