SOUTHERN LAKES ENDOSCOPY LLC (NPI# 1851887715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851887715 |
| Entity Type | Organization |
| Organization Name | SOUTHERN LAKES ENDOSCOPY LLC |
| Practice Address |
240 Maple Ave Ste 2220 Mukwonago WI 53149-8475 |
| Mailing Address |
2801 W Kinnickinnic River Pkwy Ste 1080 Milwaukee WI 53215-3689 |
| Practice Telephone | 4149086507 |
| Practice Fax Number | 4149086508 |
| Mailing Telephone | 4149086507 |
| Mailing Fax Number | 4149086508 |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2020-05-12 |
| Authorized Official Name | ROBERT KWECH (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4149086507 |
| 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 |
| Street Address |
240 MAPLE AVE STE 2220 |
| City | MUKWONAGO |
| State | WI |
| Zip Code | 53149-8475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720433790 | Orthopaedic Associates of Wisconsin Sc | Physical Medicine & Rehabilitation | 1231 S Rochester St Ste 100, Mukwonago, WI 53149 | 2016-04-27 |
| 1952724304 | Therapeutic Healing, LLC | Clinic/Center | S77 W30705 Mosher Dr., Mukwonago, WI 53149 | 2014-01-21 |
| 1659667087 | Joan Maria Stevenson | Occupational Therapist | 111 Aktinson St., Unit 2, Mukwonago, WI 53149 | 2011-06-23 |
| 1770873515 | Kimberly Lynn Schmor | Licensed Practical Nurse | 833 Pinehurst Dr, Mukwonago, WI 53149 | 2011-04-13 |
| 1952619959 | Jennifer Ann Crnkovich | Nurse Practitioner | W307 S7835 Applewood Lane, Mukwonago, WI 53149 | 2010-09-24 |
| 1841460839 | Wendy Schmidt | Occupational Therapist | 1231 S Rochester St Ste 210, Mukwonago, WI 53149 | 2008-03-05 |
| 1659589570 | Pamela Ann Mcwilliams | Dentist | 603 North Rochester St., Mukwonago, WI 53149 | 2007-05-21 |
| 1891823787 | Rosalind J Boyer-cole | Anesthesiology | S86w26640 Rustic View Ln, Mukwonago, WI 53149 | 2007-03-01 |
| 1184777435 | Michael F Connor | Dentist | 603 N Rochester Street, Mukwonago, WI 53149 | 2007-01-19 |
| 1912057159 | Leah Mary Hudson | Occupational Therapist | 103 Apollo Ct, Mukwonago, WI 53149 | 2007-01-11 |
| Find all providers in zip 53149 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
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| 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 |
| 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 |
| 1447799580 | Geneva Surgical Suites, LLC | Clinic/Center | 119 Elizabeth Lane, Genoa City, WI 53128-2124 | 2017-02-22 |
| Find all providers with the same taxonomy | ||||
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| 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.