Healthcare Provider Details

I. General information

NPI: 1689666596
Provider Name (Legal Business Name): MENOMONEE FALLS AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8045 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

N74W12501 LEATHERWOOD CT
MENOMONEE FALLS WI
53051-4490
US

V. Phone/Fax

Practice location:
  • Phone: 262-250-0950
  • Fax: 262-250-0955
Mailing address:
  • Phone: 414-777-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALICIA MAITLAND
Title or Position: SR VP FINANCE
Credential:
Phone: 414-777-0979