LAKE COUNTRY ENDOSCOPY CENTER, LLC (NPI# 1184897472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184897472 |
| Entity Type | Organization |
| Organization Name | LAKE COUNTRY ENDOSCOPY CENTER, LLC |
| Practice Address |
1185 Corporate Center Dr Suite 125 Oconomowoc WI 53066-4845 |
| Mailing Address |
2801 W Kinnickinnic River Pkwy Ste 1080 Milwaukee WI 53215-3689 |
| Practice Telephone | 4144540600 |
| Mailing Telephone | 4149086601 |
| Mailing Fax Number | 4143852980 |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2020-10-25 |
| Authorized Official Name | ROBERT MICHAEL MOLLOY (MANAGER) |
| Authorized Official Telephone | 4144540600 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1184897472 | 05 |
| Street Address |
1185 CORPORATE CENTER DR SUITE 125 |
| City | OCONOMOWOC |
| State | WI |
| Zip Code | 53066-4845 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952756769 | Orthopaedic Associates of Wisconsin Co | Orthopaedic Surgery | 1185 Corporate Center Dr, Suite 155, Oconomowoc, WI 53066 | 2016-04-29 |
| 1023494218 | Dante Leone | Physical Therapist | 1185 Corporate Center Dr, Ste. 155, Oconomowoc, WI 53066-4887 | 2015-08-11 |
| 1497184303 | Joan Elizabeth Shelley | Nurse Practitioner | 1185 Corporate Center Dr, Suite 300, Oconomowoc, WI 53066-4887 | 2013-11-01 |
| 1972935906 | Medical Eye Associates, S.c. | Eyewear Supplier (Equipment, not the service) | 1185 Corporate Center Dr, Suite 210, Oconomowoc, WI 53066-4887 | 2013-08-01 |
| 1003256652 | Alisha F Mell | Occupational Therapist | 1185 Corporate Center Dr, Suite 155, Oconomowoc, WI 53066-4887 | 2013-06-27 |
| 1225385487 | Ashley Blair Skosey | Registered Nurse | 1185 Corporate Center Dr, Suite #2, Oconomowoc, WI 53066-4887 | 2012-08-07 |
| 1871804336 | Charles Edward Allen Jr. | Family Medicine | 1185 Corporate Center Dr, Ste 175, Oconomowoc, WI 53066-4887 | 2010-06-29 |
| 1649412339 | Jennifer Lynn Scheeler | Family Medicine | 1185 Corporate Center Dr, Ste 175, Oconomowoc, WI 53066-4887 | 2009-03-27 |
| 1578783379 | James M. Powell Dc,sc | Clinic/Center | 1185 Corporate Center Dr, Oconomowoc, WI 53066-4845 | 2007-04-26 |
| 1508086380 | James Mitchell Powell | Chiropractor | 1185 Corporate Center Dr, Oconomowoc, WI 53066-4845 | 2007-04-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376109082 | Sharon Legwinski | Occupational Therapist | 2195 N. Summit Way, Oconomowoc, WI 53066 | 2019-05-17 |
| 1033676390 | Paladina Health, LLC | Family Medicine | Paladina Health Oconomowoc Sentry Equipment Circle, 966 Blue Ribbon Circle N, Oconomowoc, WI 53066 | 2019-02-22 |
| 1689145500 | Oconomowoc Developmental Training Center of Wisconsin LLC | Residential Treatment Facility, Emotionally Disturbed Children | 36100 Genesee Lake School, Oconomowoc, WI 53066 | 2018-12-17 |
| 1649748203 | Ginny Dacquisto | Dietitian, Registered | 1134 Lily Rd, Oconomowoc, WI 53066 | 2018-11-12 |
| 1174000764 | Aimee M Metzger | Social Worker | 405 E Forest St Ste 113, Oconomowoc, WI 53066 | 2018-07-26 |
| 1023482569 | Forefront Dermatology, S.c. | Dermatology | 1320 Pabst Farms Cir, Suite 180, Oconomowoc, WI 53066 | 2015-11-20 |
| 1962890475 | Monica Rodriguez | Counselor | 405 East Forest Street, Suite 119, Oconomowoc, WI 53066 | 2015-01-06 |
| 1518384643 | Kimberley Bevan | Pharmacist | 1284 East Summit Avenue, Suite 100, Oconomowoc, WI 53066 | 2014-03-26 |
| 1699098905 | Heidi Eckroth Nunnemacher | Counselor | 35315 Genesee Lake Road, Oconomowoc, WI 53066 | 2010-03-02 |
| 1669705240 | Oconomowoc Development Training Center Ll | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3222 N. Silver Cedar Rd., Oconomowoc, WI 53066 | 2009-09-14 |
| Find all providers in zip 53066 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962001958 | Apex Surgery Center Sc | Clinic/Center | 1239 Corporate Center Dr, Oconomowoc, WI 53066-4898 | 2020-10-20 |
| 1396287355 | Waukesha Medical Services, LLC | Clinic/Center | 1239 Corporate Center Dr, Oconomowoc, WI 53066-4898 | 2016-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113841 | Spine Solutions of West Bend LLC | Clinic/Center | 1000 Gateway Ct Ste 200, West Bend, WI 53095-8541 | 2020-10-29 |
| 1205454626 | Eye Surgery Center of Wisconsin, LLC | Clinic/Center | 10148 S 27th St, Oak Creek, WI 51354 | 2020-07-13 |
| 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 |
| 1275178444 | Kenosha Digestive Health Center LLC | Clinic/Center | 8220 75th St, Kenosha, WI 53142-7637 | 2019-11-12 |
| 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 |
| 1629518006 | Great Lakes Surgery LLC | Clinic/Center | 6123 Green Bay Rd Ste 101, Kenosha, WI 53142-2927 | 2017-03-03 |
| Find all providers with the same taxonomy | ||||
| City | OCONOMOWOC |
| Zip Code | 53066 |
Please comment or provide details below to improve the information on LAKE COUNTRY ENDOSCOPY CENTER, LLC.
| 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.