Healthcare Provider Details

I. General information

NPI: 1811936248
Provider Name (Legal Business Name): EAU CLAIRE SPINE & ORTHOPEDICS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 W HAMILTON AVE
EAU CLAIRE WI
54701-6925
US

IV. Provider business mailing address

659 W HAMILTON AVE
EAU CLAIRE WI
54701-6925
US

V. Phone/Fax

Practice location:
  • Phone: 715-858-0320
  • Fax: 715-858-0319
Mailing address:
  • Phone: 715-858-0320
  • Fax: 715-858-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number37931
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number37931
License Number StateWI

VIII. Authorized Official

Name: THOMAS SUNIL THOMAS
Title or Position: OWNER
Credential: MD
Phone: 715-858-0320