Healthcare Provider Details

I. General information

NPI: 1083323059
Provider Name (Legal Business Name): ORTHOPEDIC & SPINE CENTERS OF WISCONSIN, SC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BELTLINE HWY STE 601
MADISON WI
53713-2309
US

IV. Provider business mailing address

2501 W BELTLINE HWY STE 601
MADISON WI
53713-2309
US

V. Phone/Fax

Practice location:
  • Phone: 623-241-8730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON MATTHEW SANSONE
Title or Position: PRESIDENT
Credential: MD
Phone: 608-333-1849