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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