Provider Demographics
NPI:1104811918
Name:NORTH SHORE SURGICAL CENTER A WI
Entity type:Organization
Organization Name:NORTH SHORE SURGICAL CENTER A WI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HELGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:262-532-7009
Mailing Address - Street 1:7007 N RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2620
Mailing Address - Country:US
Mailing Address - Phone:414-352-3341
Mailing Address - Fax:414-247-4588
Practice Address - Street 1:7007 N RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2620
Practice Address - Country:US
Practice Address - Phone:414-352-3341
Practice Address - Fax:414-247-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical