Provider Demographics
NPI:1093522161
Name:SPINE SOLUTIONS OF SHEBOYGAN LLC
Entity type:Organization
Organization Name:SPINE SOLUTIONS OF SHEBOYGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ASHTON
Authorized Official - Last Name:SCARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-710-8162
Mailing Address - Street 1:DEPT CH 18038
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-8038
Mailing Address - Country:US
Mailing Address - Phone:920-204-6758
Mailing Address - Fax:
Practice Address - Street 1:2124 KOHLER MEMORIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3174
Practice Address - Country:US
Practice Address - Phone:920-204-6758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies