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General NPI Number Information
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NPI Number | 1194984880
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Entity Type | Organization
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Legal Business Name | FAMILY & SPORTS ORTHOPAEDIC CENTER, LLC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 1511 PARK AVE
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City | COLUMBUS
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State | WI
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Zip | 53925-2401
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Country | US
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Telephone | 920-623-3012
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Fax |
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Provider Business Mailing Address
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Address Line | 118 W MAPLE AVE
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City | BEAVER DAM
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State | WI
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Zip | 53916-2104
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Country | US
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Telephone | 920-356-1000
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ROBERT A COE
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Credential | MD
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Telephone | 920-356-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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