Provider Demographics
NPI:1891732301
Name:DODGEVILLE ORTHOPEDICS SC
Entity Type:Organization
Organization Name:DODGEVILLE ORTHOPEDICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-935-3339
Mailing Address - Street 1:833 S IOWA ST
Mailing Address - Street 2:STE 104
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1900
Mailing Address - Country:US
Mailing Address - Phone:608-935-3339
Mailing Address - Fax:608-935-1126
Practice Address - Street 1:833 S IOWA ST
Practice Address - Street 2:STE 104
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-3339
Practice Address - Fax:608-935-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI545207OtherDEAN HEALTH INSURANCE
WI21332700Medicaid
WI30748700Medicaid
WI000027048Medicare PIN
WI0787770001Medicare PIN
WI30748700Medicaid