Healthcare Provider Details

I. General information

NPI: 1831059666
Provider Name (Legal Business Name): JOHNSON CREEK ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HARTWIG BLVD
JOHNSON CREEK WI
53038
US

IV. Provider business mailing address

N15W28300 GOLF RD
PEWAUKEE WI
53072-4800
US

V. Phone/Fax

Practice location:
  • Phone: 262-303-5055
  • Fax:
Mailing address:
  • Phone: 262-303-5013
  • Fax: 262-303-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARON VAN PELT
Title or Position: CFO
Credential: CPA
Phone: 262-303-5013