Healthcare Provider Details

I. General information

NPI: 1720017973
Provider Name (Legal Business Name): SURGI CENTER OF GREATER MADISON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SCHROEDER CT STE 100
MADISON WI
53711-2525
US

IV. Provider business mailing address

4131 W LOOMIS RD STE 300
GREENFIELD WI
53221-2057
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-7246
  • Fax: 414-325-3701
Mailing address:
  • Phone: 414-325-3725
  • Fax: 414-325-3701

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: MR. VISHAL LAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-325-3737