Provider Demographics
NPI:1417923020
Name:ST.MICHAEL HOSPITAL
Entity Type:Organization
Organization Name:ST.MICHAEL HOSPITAL
Other - Org Name:COVENENT HEALTH SYSTEM, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCIAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3090
Mailing Address - Street 1:2400 W VILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4901
Mailing Address - Country:US
Mailing Address - Phone:414-527-8000
Mailing Address - Fax:
Practice Address - Street 1:2400 W VILLARD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-4901
Practice Address - Country:US
Practice Address - Phone:414-527-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11009400Medicaid
WI11009400Medicaid