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General NPI Number Information
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NPI Number | 1730909664
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Entity Type | Organization
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Legal Business Name | EC LASER AND SURGERY INSTITUTE OF WI, LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 3301 STANLEY ST
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City | STEVENS POINT
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State | WI
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Zip | 54481-1323
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Country | US
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Telephone | 715-298-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 800 N 1ST ST
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City | WAUSAU
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State | WI
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Zip | 54403-4754
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Country | US
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Telephone | 715-261-8500
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | KIMBERLY GODDARD
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Credential | COO
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Telephone | 715-261-8557
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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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