Organization
WISCONSIN SPECIALTY SURGERY CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER HARTSHORN (OFFICER/AUTHORIZED OFFICIAL)
(314) 800-2017
Entity
Organization
Contact information
Practice address
7401 104TH AVE STE 100, KENOSHA, WI 53142-7845
(262) 697-1006
Mailing address
7401 104TH AVE STE 100, KENOSHA, WI 53142-7845
(262) 697-1006
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
WI
Other
Enumeration date
05/06/2014
Last updated
10/20/2025
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