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General NPI Number Information
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NPI Number | 1164411997
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE & ORTHOPEDIC CENTER, S.C.
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 3033 W LAYTON AVE SUITE 102
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City | GREENFIELD
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State | WI
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Zip | 53221-2628
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Country | US
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Telephone | 414-647-0033
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Fax | 414-647-0079
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Provider Business Mailing Address
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Address Line | 3033 W LAYTON AVE STE 102
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City | GREENFIELD
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State | WI
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Zip | 53221-2628
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Country | US
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Telephone | 414-647-0033
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Fax | 414-647-0079
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED OFFICIAL
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Name | JENNIFER B BALDOCK
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Credential |
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Telephone | 615-234-5954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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