Organization
MCDONOUGH ORTHOPAEDIC AND SPORTS MEDICINE CENTER SC
Active
Parent organization
MCDONOUGH ORTHOPAEDIC AND SPORTS MEDICINE CENTER SC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCDONOUGH ORTHOPAEDIC AND SPORTS MEDICINE CENTER SC
Authorized official
MR. WAYNE R CHRISTIE MD (VICE PRESIDENT MCDONOUGH ORTHOPAEDI)
(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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
416963000
—
WI
Enumeration date
08/26/2005
Last updated
03/06/2009
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