Provider Demographics
NPI:1902052350
Name:SURGERY CENTER, LLC
Entity type:Organization
Organization Name:SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KODALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-761-2600
Mailing Address - Street 1:3111 W RAWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9417
Mailing Address - Country:US
Mailing Address - Phone:414-761-2600
Mailing Address - Fax:414-761-2620
Practice Address - Street 1:3111 W RAWSON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9417
Practice Address - Country:US
Practice Address - Phone:414-761-2600
Practice Address - Fax:414-761-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical