Provider Demographics
NPI:1447540463
Name:SOUTH SHORE ORTHOPEDIC SURGERY GROUP LLC
Entity type:Organization
Organization Name:SOUTH SHORE ORTHOPEDIC SURGERY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-939-9318
Mailing Address - Street 1:9120 W LOOMIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9083
Mailing Address - Country:US
Mailing Address - Phone:262-939-9318
Mailing Address - Fax:608-756-8617
Practice Address - Street 1:9120 W LOOMIS RD STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9083
Practice Address - Country:US
Practice Address - Phone:262-939-9318
Practice Address - Fax:608-756-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty