Provider Demographics
NPI:1851356786
Name:WAUSAU SURGERY CENTER LLC
Entity type:Organization
Organization Name:WAUSAU SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-842-4490
Mailing Address - Street 1:3801 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3961
Mailing Address - Country:US
Mailing Address - Phone:715-842-4490
Mailing Address - Fax:715-842-4645
Practice Address - Street 1:3801 STEWART AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3961
Practice Address - Country:US
Practice Address - Phone:715-842-4490
Practice Address - Fax:715-842-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41907700Medicaid