NPIMap

Organization Active NPI

Southeast Wisconsin Ambulatory Surgical Center S C

  • Ambulatory Surgical Clinic/Center
  • Kenosha, WI
National Provider Identifier
1225153620
Registry record updated Jul 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
52D1008619 Issued in WI
Legal business name
SOUTHEAST WISCONSIN AMBULATORY SURGICAL CENTER S C
Practice address
10105 74TH St
Suite 102
Kenosha, WI 53142-7519
Phone
(262) 697-4301
Fax
(262) 925-8409
NPI assigned
Mar 21, 2007
Last updated
Jul 7, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2014

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

Authorized official

Name
Cynthia R Cernak, DPMNPI 1467493197
Title
Owner
Phone
(262) 697-4301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 52D1008619 WI Primary

Addresses

Primary practice location

10105 74TH St
Suite 102
Kenosha, WI 53142-7519

Mailing address

10105 74TH St
Suite 102
Kenosha, WI 53142-7519
Phone (262) 697-4301

Other names 1

  • SOUTHEAST WISCONSIN SURGICAL SUITES SC Former legal business name

National Provider Directory

National Provider Directory

Locations

10105 74th St
Ste 10
Kenosha, WI 53142

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404691200000",
    "number": "1225153620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10105 74TH ST",
            "address_2": "SUITE 102",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427519",
            "telephone_number": "262-697-4301",
            "fax_number": "262-925-8409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10105 74TH ST",
            "address_2": "SUITE 102",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427519",
            "telephone_number": "262-697-4301",
            "fax_number": "262-925-8409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST WISCONSIN AMBULATORY SURGICAL CENTER S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2014-07-07",
        "status": "A",
        "authorized_official_last_name": "CERNAK",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-697-4301",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WI",
            "license": "52D1008619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHEAST WISCONSIN SURGICAL SUITES SC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; 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.