Provider Demographics
NPI:1831194448
Name:BLOUNT ORTHOPAEDIC ASSOCIATES, S.C.
Entity type:Organization
Organization Name:BLOUNT ORTHOPAEDIC ASSOCIATES, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARSICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-977-1325
Mailing Address - Street 1:525 W. RIVER WOODS PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1010
Mailing Address - Country:US
Mailing Address - Phone:414-332-6262
Mailing Address - Fax:414-332-0422
Practice Address - Street 1:525 W. RIVER WOODS PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1010
Practice Address - Country:US
Practice Address - Phone:414-332-6262
Practice Address - Fax:414-332-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200022953OtherRAILROAD MEDICARE
WI32736100Medicaid
WI32736100Medicaid
0693900001Medicare NSC
000002724Medicare PIN