Provider Demographics
NPI:1285792341
Name:SURGICAL ASSOCIATES OF NEENAH, S.C.
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF NEENAH, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-725-4527
Mailing Address - Street 1:100 THEDA CLARK MEDICAL PLZ STE 400
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2763
Mailing Address - Country:US
Mailing Address - Phone:920-725-4527
Mailing Address - Fax:920-725-0991
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:100 THEDA CLARK MED PLAZA, SUITE 400
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-725-4527
Practice Address - Fax:920-725-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI71445Medicare ID - Type UnspecifiedMEDICAR GROUP #