Healthcare Provider Details

I. General information

NPI: 1104996081
Provider Name (Legal Business Name): SPRING MEDICAL ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WEST JEFFERSON STREET
SPRING GREEN WI
53588
US

IV. Provider business mailing address

156 WEST JEFFERSON STREET P O BOX 250
SPRING GREEN WI
53588
US

V. Phone/Fax

Practice location:
  • Phone: 608-588-2600
  • Fax: 608-588-2644
Mailing address:
  • Phone: 608-588-2600
  • Fax: 608-588-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number37632
License Number StateWI

VIII. Authorized Official

Name: DR. HISHAM A OSMAN
Title or Position: FAMILY PRACTICE
Credential: M.D.
Phone: 608-588-2600