NPIMap

Organization Active NPI

Ec Laser and Surgery Institute of Wi, LLC

  • Ambulatory Surgical Clinic/Center
  • Stevens Point, WI
National Provider Identifier
1730909664
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EC LASER AND SURGERY INSTITUTE OF WI, LLC
Practice address
3301 Stanley St
Stevens Point, WI 54481-1323
Phone
(715) 298-5500
NPI assigned
Oct 15, 2024
Last updated
Oct 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EC LASER AND SURGERY INSTITUTE OF WI, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Authorized official

Name
Kimberly Goddard, COO
Title
Chief Operating Officer
Phone
(715) 261-8557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

3301 Stanley St
Stevens Point, WI 54481-1323

Mailing address

800 N 1St St
Wausau, WI 54403-4754
Phone (715) 261-8500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250213003797 WI Part B Supplier - Ambulatory Surgical Center 4789834557 Practice locations: Stevens Point, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730909664. Details of each certification follow.

Ambulatory surgical center certification: CCN 52C0001161

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
EC Laser and Surgery Institute of WI, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jul 30, 2025
Last certification
Jul 30, 2025
Facility address
3301 Stanley St.
Stevens Point, WI 54481

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2318042Ec Laser and Surgery Institute of Wi, LLC3301 Stanley Street, Stevens Point, WI 54481Certificate of waiverFeb 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ec Laser Surgery Institute2 organizations share this tax ID, including this one
Part of
Ec Laser Surgery Institute

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1730909664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N 1ST ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544034754",
            "telephone_number": "715-261-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 STANLEY ST",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544811323",
            "telephone_number": "715-298-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EC LASER AND SURGERY INSTITUTE OF WI, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EC LASER AND SURGERY INSTITUTE OF WI, LLC",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "GODDARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "715-261-8557",
        "authorized_official_credential": "COO"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stevens Point, WI

Sources for this page

Verify at the official NPI Registry.