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General NPI Number Information
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NPI Number | 1346235058
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Entity Type | Organization
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Legal Business Name | EAST MEQUON SURGERY CENTER LLC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 12203 CORPORATE PKWY
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City | MEQUON
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State | WI
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Zip | 53092-3388
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Country | US
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Telephone | 262-387-8383
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Fax | 262-387-8384
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Provider Business Mailing Address
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Address Line | PO BOX 909981
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City | MILWAUKEE
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State | WI
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Zip | 53209-8981
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Country | US
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Telephone | 414-352-3341
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Fax | 414-247-4588
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Authorized Official
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Title or Position | ASSISTANT TREASURER
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Name | KARA RICHARDSON
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Credential |
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Telephone | 704-631-0450
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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 | WI
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