MEDICARE: FROEDTERT SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	2014993545	WI

General Provider Information

NPI Number	:	1508851213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FROEDTERT SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	N74W12501 LEATHERWOOD CT
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-4490
Country	:	US
Telephone Number	:	414-777-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 N 87TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3586
Country	:	US
Telephone Number	:	414-805-9500
Fax Number	:	414-805-9501

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT, SERVICE LINE
Name	:	SUSAN CAMPBELL
Credential	:
Telephone Number	:	414-805-2230

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	12/15/2025

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