Provider Demographics
NPI:1386387116
Name:MADISON SURGICENTER LLC
Entity type:Organization
Organization Name:MADISON SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-531-4327
Mailing Address - Street 1:2500 W LAYTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5434
Mailing Address - Country:US
Mailing Address - Phone:262-297-7246
Mailing Address - Fax:
Practice Address - Street 1:34 SCHROEDER CT STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2528
Practice Address - Country:US
Practice Address - Phone:608-291-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical