Healthcare Provider Details

I. General information

NPI: 1659316396
Provider Name (Legal Business Name): FALL GENERAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 3RD ST W SUITE 201
ASHLAND WI
54806-1602
US

IV. Provider business mailing address

216 3RD ST W SUITE 201
ASHLAND WI
54806-1602
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-0656
  • Fax:
Mailing address:
  • Phone: 715-685-0656
  • Fax: 715-685-9326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34121
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE A FALL
Title or Position: OWNER MEMBER
Credential: MD
Phone: 715-685-0656