# SPORTS MEDICINE CENTER S C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093729055
- **Authorized official:** DR. ETIENNE A MEJIA M.D. (PRESDIENT)
- **Authorized official phone:** (920) 993-1643

## Contact information

- **Practice address:** 277 ALTENHOFEN DR, APPLETON, WI 54913-8401
- **Practice address phone:** (920) 993-1643
- **Practice address fax:** (920) 993-1645
- **Mailing address:** 277 ALTENHOFEN DR, APPLETON, WI 54913-8401
- **Mailing address phone:** (920) 993-1643
- **Mailing address fax:** (920) 993-1645

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 01/20/2009