Provider Demographics
NPI:1982775383
Name:SURGICAL PARTNERS, S.C.
Entity Type:Organization
Organization Name:SURGICAL PARTNERS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-524-2349
Mailing Address - Street 1:1104 21ST STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-2214
Mailing Address - Country:US
Mailing Address - Phone:608-524-2349
Mailing Address - Fax:
Practice Address - Street 1:1104 21ST STREET
Practice Address - Street 2:SUITE B
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-2214
Practice Address - Country:US
Practice Address - Phone:608-524-2349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21288100Medicaid
WI21288100Medicaid