Provider Demographics
NPI:1891975801
Name:UROLOGICAL SURGERY S.C.
Entity Type:Organization
Organization Name:UROLOGICAL SURGERY S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BROWNING
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:920-907-7450
Mailing Address - Street 1:700 PARK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-1385
Mailing Address - Country:US
Mailing Address - Phone:920-907-7450
Mailing Address - Fax:920-907-7410
Practice Address - Street 1:700 PARK RIDGE LN
Practice Address - Street 2:
Practice Address - City:NORTH FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-1385
Practice Address - Country:US
Practice Address - Phone:920-907-7450
Practice Address - Fax:920-907-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31703400Medicaid
WI4386580001Medicare NSC
WI000022045Medicare PIN
WIE84787Medicare UPIN