Provider Demographics
NPI:1922316835
Name:INDEPENDENT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:INDEPENDENT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-797-8310
Mailing Address - Street 1:1115 E LOWES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7439
Mailing Address - Country:US
Mailing Address - Phone:715-797-8310
Mailing Address - Fax:
Practice Address - Street 1:2751 COMMERCIAL BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5079
Practice Address - Country:US
Practice Address - Phone:715-797-8310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical