Provider Demographics
NPI:1851336044
Name:ST. JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC.
Entity Type:Organization
Organization Name:ST. JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC.
Other - Org Name:FROEDTERT WEST BEND HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERICSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-836-8391
Mailing Address - Street 1:N74W12501 LEATHERWOOD CT STE 103
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4490
Mailing Address - Country:US
Mailing Address - Phone:414-777-0417
Mailing Address - Fax:414-777-0096
Practice Address - Street 1:3200 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9274
Practice Address - Country:US
Practice Address - Phone:262-334-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32946800OtherT19 REF LAB #
WI41664800Medicaid
WI32770300Medicaid
WI11011200Medicaid
WI11011200Medicaid
WI32770300Medicaid
WI0514980001Medicare NSC