Provider Demographics
NPI:1548300460
Name:NORTHERN WISCONSIN BONE & JOINT CENTER, LTD
Entity type:Organization
Organization Name:NORTHERN WISCONSIN BONE & JOINT CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEJNICZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-358-7965
Mailing Address - Street 1:7520 US HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9202
Mailing Address - Country:US
Mailing Address - Phone:715-358-1911
Mailing Address - Fax:715-358-1912
Practice Address - Street 1:201 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-8835
Practice Address - Country:US
Practice Address - Phone:715-358-1911
Practice Address - Fax:715-358-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1052540001OtherDMERC
WI21298800Medicaid
WICQ2410OtherRRMEDICARE
WI21298800Medicaid
WI=========Medicare UPIN