Healthcare Provider Details

I. General information

NPI: 1508936642
Provider Name (Legal Business Name): SHEBOYGAN ORTHOPAEDIC ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 SUPERIOR AVENUE
SHEBOYGAN WI
53081
US

IV. Provider business mailing address

2920 SUPERIOR AVENUE
SHEBOYGAN WI
53081
US

V. Phone/Fax

Practice location:
  • Phone: 920-458-3791
  • Fax: 920-458-3783
Mailing address:
  • Phone: 920-458-3791
  • Fax: 920-458-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: D SCOTT SELLINGER
Title or Position: PARTNER OFFICER 5 PER OR MORE OWNER
Credential: MD
Phone: 920-458-3791