Provider Demographics
NPI:1841361417
Name:SHEBOYGAN ORTHOPAEDIC ASSOCIATES SC
Entity type:Organization
Organization Name:SHEBOYGAN ORTHOPAEDIC ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OFFICER 5 PER OR MORE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-458-8707
Mailing Address - Street 1:2920 SUPERIOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-458-8707
Mailing Address - Fax:920-452-6107
Practice Address - Street 1:2920 SUPERIOR AVENUE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-458-8707
Practice Address - Fax:920-452-6107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEBOYGAN ORTHOPAEDIC ASSOCIATES SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40426300Medicaid
WI0589550001Medicare NSC
WI80045Medicare ID - Type Unspecified