Healthcare Provider Details

I. General information

NPI: 1558373977
Provider Name (Legal Business Name): NORTHLAND ORTHOPEDIC ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E TIMBER DR
RHINELANDER WI
54501-2852
US

IV. Provider business mailing address

444 E TIMBER DR
RHINELANDER WI
54501-2852
US

V. Phone/Fax

Practice location:
  • Phone: 715-369-2300
  • Fax: 715-369-2482
Mailing address:
  • Phone: 715-369-2300
  • Fax: 715-369-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateWI

VIII. Authorized Official

Name: JAMES R DYREBY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 715-369-2300