Healthcare Provider Details

I. General information

NPI: 1790819886
Provider Name (Legal Business Name): NORTHWEST SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N MAYFAIR RD STE 304
MILWAUKEE WI
53226-3255
US

IV. Provider business mailing address

1233 N MAYFAIR RD STE 304
MILWAUKEE WI
53226-3255
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-3322
  • Fax: 414-257-3364
Mailing address:
  • Phone: 414-257-3322
  • Fax: 414-257-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GAIL J ODEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 414-257-3322