Provider Demographics
NPI:1871645333
Name:ORTHOPAEDIC SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-725-0077
Mailing Address - Street 1:1516 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4802
Mailing Address - Country:US
Mailing Address - Phone:920-725-0077
Mailing Address - Fax:920-725-6535
Practice Address - Street 1:1516 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4802
Practice Address - Country:US
Practice Address - Phone:920-725-0077
Practice Address - Fax:920-725-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
WI21334200332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21334200Medicaid
WI71420Medicare ID - Type Unspecified
WI21334200Medicaid