Organization Name: | FAMILY & SPORTS ORTHOPAEDIC CENTER, LLC |
NPI Number: | 1467565978 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT A COE (MEMBER) |
Mailing Address: | 118 W Maple Ave Beaver Dam |
State: | WI US |
Postal Code: | 539162104 |
Phone Number: | 9203561000 |
Fax Number: | 9203560719 |
NPI Enumeration Date: | 08/17/2006 |
NPI Last Update Date: | 03/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 36330 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |