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Organization
FAMILY & SPORTS ORTHOPAEDIC CENTER, LLC
Active
Organization
FAMILY & SPORTS ORTHOPAEDIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A COE MD (MEMBER)
(920) 356-1000
Entity
Organization
Contact information
Practice address
1511 PARK AVE, COLUMBUS, WI 53925-2401
(920) 623-3012
Mailing address
118 W MAPLE AVE, BEAVER DAM, WI 53916-2104
(920) 356-1000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003837
PHYSICIAN PLUS
WI
01
—
11801
DEAN CARE
WI
01
—
15104
DEAN CARE
WI
01
—
15909
DEAN
WI
01
—
159462492004
BCBS
WI
01
—
2028274
PHYSICIANS PLUS
WI
01
—
2033322
PHYSICIANS PLUS
WI
05
—
30082300
—
WI
05
—
32123200
—
WI
05
—
36027400
—
WI
01
—
391796912
WPS
WI
05
—
43020200
—
WI
Enumeration date
06/06/2008
Last updated
03/18/2011
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