WISCONSIN SPECIALTY SURGERY CENTER,LLC


Address: 7401 104th Ave Ste 100, Kenosha, WI 53142-7845
Phone: 2626971006

WISCONSIN SPECIALTY SURGERY CENTER,LLC (NPI# 1053721530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1053721530
Entity Type Organization
Organization Name WISCONSIN SPECIALTY SURGERY CENTER,LLC
Practice Address 7401 104th Ave Ste 100
Kenosha
WI 53142-7845
Practice Telephone 2626971006
Mailing Telephone 2626971006
Enumeration Date 2014-05-06
Last Update Date 2019-11-04
Authorized Official Name KRISTY MINATTO (RN, ADMINISTRATOR)
Authorized Official Telephone 2626971006
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QA1903X Clinic/Center
Specialization: Ambulatory Surgical
WI Ambulatory Health Care Facilities

Office Location

Street Address 7401 104TH AVE STE 100
City KENOSHA
State WI
Zip Code 53142-7845

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1225409485 Antonia Marie Decker Physician Assistant 10400 75th St. Ste 204, Kenosha, WI 53142 2015-10-14
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1811379225 Dana Mary Stout Registered Nurse 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 2015-06-22
1669815569 Joshua Knute Elson Radiology 6811 118th Ave, Kenosha, WI 53142 2013-04-10
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Taxonomy Information

Taxonomy Code 261QA1903X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Ambulatory Surgical

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1629518006 Great Lakes Surgery LLC Clinic/Center 6123 Green Bay Rd Ste 101, Kenosha, WI 53142-2927 2017-03-03
1588041008 Tri County Medical LLC Clinic/Center 7611 Pershing Blvd, Kenosha, WI 53142-4317 2015-05-05
1104131960 Green Bay Road Medical Services Inc Clinic/Center 6127 Green Bay Road, Suite 600, Kenosha, WI 53142-2930 2010-08-17
1700045168 Great Lakes Surgery Center LLC Clinic/Center 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2927 2008-06-02
1225153620 Southeast Wisconsin Ambulatory Surgical Center S C Clinic/Center 10105 74th St, Suite 102, Kenosha, WI 53142-7519 2007-03-21

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1083242325 Appleton Surgical Center LLC Clinic/Center 1616 N Casaloma Dr # 200, Appleton, WI 54913-8245 2020-03-31
1164056974 Orthopedic Surgery Center of The Fox Valley LLC Clinic/Center 1205 W. American Drive, Neenah, WI 54596-5459 2020-03-02
1013548833 Ascension Wisconsin Surgery Center-mount Pleasant LLC Clinic/Center 10180 Washington Ave Ste 200, Mount Pleasant, WI 53177-1604 2020-01-30
1497393516 Aurora Surgery Centers, LLC Clinic/Center 12500 Aurora Drive, Pleasant Prairie, WI 53158 2019-12-19
1851887715 Southern Lakes Endoscopy LLC Clinic/Center 240 Maple Ave Ste 2220, Mukwonago, WI 53149-8475 2018-07-03
1447768411 Wisconsin Institute of Surgical Excellence LLC Clinic/Center 1265 W American Dr Ste 200, Neenah, WI 54956 2018-01-12
1447799580 Geneva Surgical Suites, LLC Clinic/Center 119 Elizabeth Lane, Genoa City, WI 53128-2124 2017-02-22
1659810703 Milwaukee Surgical Suites, LLC Clinic/Center 6495 S 27th St, Franklin, WI 53132-8034 2017-02-21
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Competitor

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City KENOSHA
Zip Code 53142

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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