Northeast Wisconsin Surgical Assistants, LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

NORTHEAST WISCONSIN SURGICAL ASSISTANTS, LLC

Practice address

4321 W College Ave Ste 200
Appleton, WI 54914-3968

Phone

(210) 598-4277

NPI assigned

Mar 23, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Roxanna Campbell

Title

Director of Client Experience

Phone

(210) 598-4277

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1033745930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 N LOOP 1604 E #105-612",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78232",
            "telephone_number": "210-598-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 W COLLEGE AVE STE 200",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143968",
            "telephone_number": "210-598-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST WISCONSIN SURGICAL ASSISTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-23",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "ROXANNA",
        "authorized_official_title_or_position": "DIRECTOR OF CLIENT EXPERIENCE",
        "authorized_official_telephone_number": "210-598-4277"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Appleton, WI
• Providers in Appleton, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.