MEDICARE: INDEPENDENT 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

General Provider Information

NPI Number	:	1922316835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1115 E LOWES CREEK RD
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-7439
Country	:	US
Telephone Number	:	715-797-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 COMMERCIAL BLVD
Second Line	:	SUITE 7
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-5079
Country	:	US
Telephone Number	:	715-797-8310
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHANIE HARVEY
Credential	:
Telephone Number	:	715-797-8310

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	09/14/2010

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