Provider Demographics
NPI:1447355243
Name:SURGICENTER OF GREATER MILWAUKEE, LLC
Entity type:Organization
Organization Name:SURGICENTER OF GREATER MILWAUKEE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE VP AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CADIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-6226
Mailing Address - Street 1:PO BOX 88842
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53288-0001
Mailing Address - Country:US
Mailing Address - Phone:414-328-5800
Mailing Address - Fax:414-328-5805
Practice Address - Street 1:3223 S 103RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4103
Practice Address - Country:US
Practice Address - Phone:414-328-5800
Practice Address - Fax:414-328-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41906900Medicaid
WI41906900Medicaid