Provider Demographics
NPI:1043467277
Name:WISCONSIN CRH SURGEONS, SC
Entity type:Organization
Organization Name:WISCONSIN CRH SURGEONS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:425-284-7890
Mailing Address - Street 1:9200 W LOOMIS RD
Mailing Address - Street 2:#106
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8887
Mailing Address - Country:US
Mailing Address - Phone:425-284-7890
Mailing Address - Fax:425-284-7896
Practice Address - Street 1:4040 LAKE WASHINGTON BLVD NE
Practice Address - Street 2:#100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7874
Practice Address - Country:US
Practice Address - Phone:425-284-7890
Practice Address - Fax:425-284-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty