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General NPI Number Information
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NPI Number | 1831059666
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Entity Type | Organization
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Legal Business Name | JOHNSON CREEK ASC LLC
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 350 HARTWIG BLVD
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City | JOHNSON CREEK
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State | WI
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Zip | 53038
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Country | US
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Telephone | 262-303-5055
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Fax |
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Provider Business Mailing Address
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Address Line | N15W28300 GOLF RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-4800
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Country | US
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Telephone | 262-303-5013
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Fax | 262-303-5057
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Authorized Official
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Title or Position | CFO
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Name | ARON VAN PELT
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Credential | CPA
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Telephone | 262-303-5013
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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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