Organization
MIDWEST ALLIANCE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS DAVID BOOSTROM CRNA (CO-OWNER)
(507) 206-1680
Entity
Organization
Contact information
Practice address
800 N. 1ST ST., WAUSAU, WI 54403
(715) 261-8500
Mailing address
5261 SANDY LOOP, RHINELANDER, WI 54501
(507) 206-1680
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
01/09/2019
Last updated
04/11/2019
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