Provider Demographics
NPI:1821757378
Name:ASCENSION MEDICAL GROUP - SOUTHEAST WISCONSIN, INC.
Entity Type:Organization
Organization Name:ASCENSION MEDICAL GROUP - SOUTHEAST WISCONSIN, INC.
Other - Org Name:ASCENSION WISCONSIN EMPLOYER SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:FISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-748-7617
Mailing Address - Street 1:1186 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1906
Mailing Address - Country:US
Mailing Address - Phone:715-295-5280
Mailing Address - Fax:
Practice Address - Street 1:1001 15TH AVE # DOOR56
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-1503
Practice Address - Country:US
Practice Address - Phone:414-766-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION MEDICAL GROUP - SOUTHEAST WISCONSIN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-13
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine