Healthcare Provider Details

I. General information

NPI: 1134140122
Provider Name (Legal Business Name): ARTHROSCOPIC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 ALTENHOFEN DR
APPLETON WI
54913-8401
US

IV. Provider business mailing address

277 ALTENHOFEN DR
APPLETON WI
54913-8401
US

V. Phone/Fax

Practice location:
  • Phone: 920-993-1643
  • Fax: 920-993-1645
Mailing address:
  • Phone: 920-993-1643
  • Fax: 920-993-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ETIENNE A MEJIA
Title or Position: OWNER
Credential: M.D.
Phone: 920-993-1643