# ORTHOPEDIC SURGERY CENTER OF GREEN BAY, LLC

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

## Provider details

- **NPI number:** 1922334101
- **Authorized official:** SANDY FRAGALE (CHAIRMAN OF THE BOARD)
- **Authorized official phone:** (920) 965-9520

## Contact information

- **Practice address:** 2223 LIME KILN RD STE 2, GREEN BAY, WI 54311-6213
- **Practice address phone:** (920) 965-9520
- **Mailing address:** 2223 LIME KILN RD STE 1, GREEN BAY, WI 54311-6213
- **Mailing address phone:** (920) 965-9520
- **Mailing address fax:** (920) 430-8122

## Taxonomy

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

## Other

- **Enumeration date:** 10/23/2009
- **Last updated:** 01/18/2021