Wauwatosa Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WAUWATOSA SURGERY CENTER, LLC

Practice address

10900 W Potter Rd
Wauwatosa, WI 53226-3424

Phone

(414) 774-9227

NPI assigned

Apr 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Tony Willbur

Title

Chief Administrative Officer

Phone

(414) 208-4456

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Listed as

Wauwatosa Surgery Center Limited Partnership Dba Wauwatosa Surgery CenterCCN 52C0001007

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1275598302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10900 W POTTER RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10900 W POTTER RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263424",
            "telephone_number": "414-774-9227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUWATOSA SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "WILLBUR",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "414-208-4456",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.