Healthcare Provider Details

I. General information

NPI: 1194813840
Provider Name (Legal Business Name): SURGERY CENTER OF WISCONSIN RAPIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 24TH ST S
WISCONSIN RAPIDS WI
54494-1906
US

IV. Provider business mailing address

PO BOX 8005
WISCONSIN RAPIDS WI
54495-8005
US

V. Phone/Fax

Practice location:
  • Phone: 715-424-1881
  • Fax: 715-423-1602
Mailing address:
  • Phone: 715-424-1881
  • Fax: 715-423-1602

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: JESSICA SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-424-1881