# FAMILY & SPORTS ORTHOPAEDIC CENTER, LLC

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

## Provider details

- **NPI number:** 1194984880
- **Authorized official:** ROBERT A COE MD (MEMBER)
- **Authorized official phone:** (920) 356-1000

## Contact information

- **Practice address:** 1511 PARK AVE, COLUMBUS, WI 53925-2401
- **Practice address phone:** (920) 623-3012
- **Mailing address:** 118 W MAPLE AVE, BEAVER DAM, WI 53916-2104
- **Mailing address phone:** (920) 356-1000

## Taxonomy

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

## Other

- **Enumeration date:** 06/06/2008
- **Last updated:** 03/18/2011

## 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 |