Provider Demographics
NPI:1881354165
Name:APEX ASC KENOSHA LLC
Entity type:Organization
Organization Name:APEX ASC KENOSHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEYROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-800-5005
Mailing Address - Street 1:10105 74TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7530
Mailing Address - Country:US
Mailing Address - Phone:678-800-5005
Mailing Address - Fax:
Practice Address - Street 1:10105 74TH ST STE 102
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7530
Practice Address - Country:US
Practice Address - Phone:678-800-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical