MEDICARE: TOWER CLOCK SURGERY CENTER APPLETON, 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

General Provider Information

NPI Number	:	1568244192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWER CLOCK SURGERY CENTER APPLETON, LLC

Provider Business Mailing Address
First Line	:	3120 N RICHMOND ST
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-1151
Country	:	US
Telephone Number	:	920-497-1810
Fax Number	:	920-497-1830

Provider Business Practice Location Address
First Line	:	3120 N RICHMOND ST
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-1151
Country	:	US
Telephone Number	:	920-497-1810
Fax Number	:	920-497-1830

Authorized Official
Title or Position	:	OWNER/OPHTHALMOLOGIST
Name	:	DR. MATTHEW J THOMPSON
Credential	:	MD
Telephone Number	:	920-497-1810

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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