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General NPI Number Information
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NPI Number | 1174796668
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF SHEBOYGAN LLC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 3141 SAEMANN AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081
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Country | US
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Telephone | 920-783-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 3141 SAEMANN AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081
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Country | US
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Telephone | 920-783-5000
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MRS. SARA M MCCALLUM
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Credential | RN, MBA, CASC
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Telephone | 920-783-1250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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