Organization
ST. CROIX VALLEY SURGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA LARSON (OFFICE MANAGER)
(715) 294-4898
Entity
Organization
Contact information
Practice address
204 3RD AVENUE, OSCEOLA, WI 54020-0597
(715) 294-4898
Mailing address
204 3RD AVENUE, PO BOX 597, OSCEOLA, WI 54020-0597
(715) 294-4898
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
38459
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32892400
—
WI
01
—
36163
MINNESOTA LICENSE
MN
01
—
38459
WISCONSIN LICENSE
WI
Enumeration date
09/28/2006
Last updated
08/22/2020
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