# NORTHERN WISCONSIN BONE AND JOINT CENTER

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

## Provider details

- **NPI number:** 1386828549
- **Authorized official:** LISA MARIE TADYCH (CORPORATE SECRETARY)
- **Authorized official phone:** (715) 358-1911

## Contact information

- **Practice address:** 611 VETERANS PARKWAY, WOODRUFF, WI 54568
- **Practice address phone:** (715) 358-8600
- **Mailing address:** 7520 US HIGHWAY 51 S, STE A, MINOCQUA, WI 54548-8944
- **Mailing address phone:** (715) 358-1911

## Taxonomy

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

## Other

- **Enumeration date:** 12/24/2007
- **Last updated:** 02/22/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000044000 | MEDICARE ID | WI |
| 01 | — | 1052540001 | DMERC | WI |
| 05 | — | 21298800 | — | WI |
| 01 | — | CQ2410 | RAILROAD MEDICARE | WI |