# SOUTHEAST WISCONSIN SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1619611142
- **Authorized official:** DR. CHELSIE LISLE CRNA (CO-OWNER)
- **Authorized official phone:** (402) 631-8892

## Contact information

- **Practice address:** 3801 WASHINGTON AVE, RACINE, WI 53405-2853
- **Practice address phone:** (414) 949-1938
- **Mailing address:** 3801 WASHINGTON AVE, RACINE, WI 53405-2853
- **Mailing address phone:** (402) 631-8892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/21/2022
- **Last updated:** 08/28/2023