Provider Demographics
NPI:1629575709
Name:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Other - Org Name:CHILDREN'S HOSPITAL OF WISCONSIN-PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. FINANCIAL ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-3881
Mailing Address - Street 1:PO BOX 1997
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-1997
Mailing Address - Country:US
Mailing Address - Phone:414-266-2000
Mailing Address - Fax:414-266-6338
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2000
Practice Address - Fax:414-266-6338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI135333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33171800Medicaid