Healthcare Provider Details

I. General information

NPI: 1497599609
Provider Name (Legal Business Name): PREMIER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DIVISION ST STE H
STEVENS POINT WI
54481-1843
US

IV. Provider business mailing address

520 VINCENT ST
STEVENS POINT WI
54481-1848
US

V. Phone/Fax

Practice location:
  • Phone: 715-544-1775
  • Fax: 715-544-1769
Mailing address:
  • Phone: 715-544-1775
  • Fax: 715-544-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TODD A FAIRCHILD
Title or Position: MEMBER
Credential: MD
Phone: 715-544-1775