Healthcare Provider Details

I. General information

NPI: 1699778829
Provider Name (Legal Business Name): CHIPPEWA VALLEY ORTHOPEDICS AND SPORTS MEDICINE CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OAKLEAF WAY STE A
ALTOONA WI
54720-2217
US

IV. Provider business mailing address

1200 OAKLEAF WAY STE A
ALTOONA WI
54720-2217
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-1400
  • Fax: 715-832-4187
Mailing address:
  • Phone: 715-832-1400
  • Fax: 715-832-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number54216
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. AUSTIN JAY CROW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 715-832-1400