Healthcare Provider Details

I. General information

NPI: 1891732301
Provider Name (Legal Business Name): DODGEVILLE ORTHOPEDICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S IOWA ST STE 104
DODGEVILLE WI
53533-1900
US

IV. Provider business mailing address

833 S IOWA ST STE 104
DODGEVILLE WI
53533-1900
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-3339
  • Fax: 608-935-1126
Mailing address:
  • Phone: 608-935-3339
  • Fax: 608-935-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS R PALMER
Title or Position: OWNER
Credential: MD
Phone: 608-935-3339