Healthcare Provider Details

I. General information

NPI: 1427153436
Provider Name (Legal Business Name): FOUNTAIN CITY SURGICAL ASSOCIATES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WISCONSIN AMERICAN DR SUITE 265
FOND DU LAC WI
54935-2999
US

IV. Provider business mailing address

210 WISCONSIN AMERICAN DR SUITE 265
FOND DU LAC WI
54935-2999
US

V. Phone/Fax

Practice location:
  • Phone: 920-907-7400
  • Fax: 920-907-7401
Mailing address:
  • Phone: 920-907-7400
  • Fax: 920-907-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BECKY K MCDOWELL
Title or Position: ACCOUNTS RECEIVABLES
Credential:
Phone: 920-907-7400