Provider Demographics
NPI:1750482022
Name:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-2511
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:414-266-6409
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3518
Practice Address - Country:US
Practice Address - Phone:414-266-2000
Practice Address - Fax:414-266-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1351223P0221X, 282NC2000X, 291U00000X, 332B00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildrenGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119026105Medicaid
CAXHSP33461Medicaid
NY01509640Medicaid
MS00095382Medicaid
GA00435179XMedicaid
KY01700160Medicaid
IN100037470AMedicaid
OH6014253Medicaid
CAXHSP43461Medicaid
WI11019700Medicaid
MI30-4655055Medicaid
MO013436506Medicaid
IA0944108Medicaid
MND0927520-00Medicaid
FL11530400Medicaid
MI40-4655064Medicaid
KS01 86806201Medicaid
NY01509640Medicaid
MS00095382Medicaid
NY01509640Medicaid