Provider Demographics
NPI:1376541748
Name:ASCENSION CALUMET HOSPITAL, INC
Entity Type:Organization
Organization Name:ASCENSION CALUMET HOSPITAL, INC
Other - Org Name:ASCENSION CALUMET HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3000
Mailing Address - Street 1:614 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-1568
Mailing Address - Country:US
Mailing Address - Phone:920-849-2386
Mailing Address - Fax:920-849-1801
Practice Address - Street 1:614 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1568
Practice Address - Country:US
Practice Address - Phone:920-849-2386
Practice Address - Fax:920-849-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1020282NC0060X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11015300Medicaid
WI11015300Medicaid
WI52-1317Medicare ID - Type UnspecifiedIP/OP MEDICARE
WI52-Z317Medicare Oscar/Certification