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Organization
MCDONOUGH ORTHOPAEDIC AND SPORTS MEDICINE CENTER SC
Active
Organization
MCDONOUGH ORTHOPAEDIC AND SPORTS MEDICINE CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE R CHRISTIE MD (VICE PRESIDENT)
(715) 421-5257
Entity
Organization
Contact information
Practice address
410 DEWEY ST, WISCONSIN RAPIDS, WI 54494-4715
(715) 421-5257
(715) 421-0111
Mailing address
PO BOX 8075, WISCONSIN RAPIDS, WI 54495-8075
(715) 421-5257
(715) 421-0111
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
WI
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32685600
—
WI
Enumeration date
08/26/2005
Last updated
03/05/2009
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