Provider Demographics
NPI:1295404689
Name:ASCENSION SACRED HEART - ST MARY'S HOSPITALS, INC.
Entity Type:Organization
Organization Name:ASCENSION SACRED HEART - ST MARY'S HOSPITALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-748-2988
Mailing Address - Street 1:29980 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1299
Mailing Address - Country:US
Mailing Address - Phone:715-847-2304
Mailing Address - Fax:715-847-2125
Practice Address - Street 1:4348 HWY B
Practice Address - Street 2:UNIT B
Practice Address - City:LAND O LAKES
Practice Address - State:WI
Practice Address - Zip Code:54540-9635
Practice Address - Country:US
Practice Address - Phone:715-547-6118
Practice Address - Fax:715-547-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center