Healthcare Provider Details

I. General information

NPI: 1073101655
Provider Name (Legal Business Name): PLASTIC SURGERY CLINIC OF EC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 3RD AVE W
DURAND WI
54736-1600
US

IV. Provider business mailing address

3221 STEIN BLVD STE 2
EAU CLAIRE WI
54701-4399
US

V. Phone/Fax

Practice location:
  • Phone: 715-672-4211
  • Fax:
Mailing address:
  • Phone: 715-833-2116
  • Fax: 715-833-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMBER LEE EWINGS
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 715-833-2116