Provider Demographics
NPI:1891808671
Name:NEW SURGICAL ASSOCIATES SC
Entity type:Organization
Organization Name:NEW SURGICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERLACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-497-7678
Mailing Address - Street 1:670 CORMIER ROAD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304
Mailing Address - Country:US
Mailing Address - Phone:920-494-9685
Mailing Address - Fax:920-494-8417
Practice Address - Street 1:670 CORMIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4824
Practice Address - Country:US
Practice Address - Phone:920-494-9685
Practice Address - Fax:920-494-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
44472OtherLICENSE SCOTT L RUGGLES
34387OtherPETER M FALK
35428OtherLICENSE JAMES M KEMMERLIN
39619OtherLICENSE PETER W DAVIS
WICI5843OtherRAILROAD MEDICARE