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Organization

STATELINE ANESTHESIOLOGISTS SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JIMSON C TSE MD (PRESIDENT OF CORPORATION)
(608) 362-7444
Entity
Organization

Contact information

Practice address
1969 W HART RD, BELOIT MEMORIAL HOSPITAL, BELOIT, WI 53511-2230
(608) 364-5355
(608) 362-0417
Mailing address
PO BOX 686, BELOIT, WI 53512-0686
(608) 362-7444
(608) 362-0417

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32828100
WI
01
541844
DEANCARE
WI
Enumeration date
10/27/2005
Last updated
06/25/2014
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