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General NPI Number Information
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NPI Number | 1225058514
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF WISCONSIN RAPIDS SC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 420 DEWEY ST SUITE 2
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-4714
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Country | US
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Telephone | 715-422-7771
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Fax | 715-424-4404
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Provider Business Mailing Address
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Address Line | 420 DEWEY ST SUITE 2
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-4714
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Country | US
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Telephone | 715-422-7771
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Fax | 715-424-4404
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARJORIE S MILLER
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Credential | M.D.
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Telephone | 715-422-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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