Organization
VALLEY ORTHOPEDIC CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY SOMMERVILLE (DIRECTOR)
(920) 731-6611
Entity
Organization
Contact information
Practice address
2105 E ENTERPRISE AVE, STE 111, APPLETON, WI 54913-7862
(920) 731-6611
(920) 731-6732
Mailing address
2105 E ENTERPRISE AVE, STE 111, APPLETON, WI 54913-7862
(920) 731-6611
(920) 731-6732
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32748000
—
WI
Enumeration date
06/16/2006
Last updated
05/11/2022
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