Provider Demographics
NPI:1376582775
Name:COLUMBIA ST MARY'S HOSPITAL OZAUKEE, INC.
Entity Type:Organization
Organization Name:COLUMBIA ST MARY'S HOSPITAL OZAUKEE, INC.
Other - Org Name:ASCENSION COLUMBIA ST MARY'S HOSPITAL OZAUKEE
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 1:13111 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2416
Mailing Address - Country:US
Mailing Address - Phone:262-243-7300
Mailing Address - Fax:
Practice Address - Street 1:13111 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2416
Practice Address - Country:US
Practice Address - Phone:262-243-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32869300Medicaid
WI21262500, 21268700Medicaid
WI21262700, 21262400Medicaid
WI21279900Medicaid
WI32757400, 21262600Medicaid
WI38997300, 21273300Medicaid
WI32869300Medicaid
WI21262700, 21262400Medicaid
WI46050, 46165, 46115Medicare UPIN
WI21262500, 21268700Medicaid
WI46030, 46004, 46230Medicare UPIN