Provider Demographics
NPI:1003836867
Name:ORTHOPEDIC AND SPORTS INSTITUTE OF THE FOX VALLEY, S.C.
Entity type:Organization
Organization Name:ORTHOPEDIC AND SPORTS INSTITUTE OF THE FOX VALLEY, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHAUFELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-560-1000
Mailing Address - Street 1:2105 E ENTERPRISE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7862
Mailing Address - Country:US
Mailing Address - Phone:920-560-1000
Mailing Address - Fax:920-731-7133
Practice Address - Street 1:2105 E ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7862
Practice Address - Country:US
Practice Address - Phone:920-560-1000
Practice Address - Fax:920-731-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34294100Medicaid
H34566Medicare UPIN