Provider Demographics
NPI:1003069428
Name:ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC
Entity type:Organization
Organization Name:ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-ASCENSION WI EMPLOYER SOLUTIONS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3600
Mailing Address - Street 1:400 W RIVER WOODS PKWY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1060
Mailing Address - Country:US
Mailing Address - Phone:414-465-3600
Mailing Address - Fax:
Practice Address - Street 1:1186 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1906
Practice Address - Country:US
Practice Address - Phone:920-727-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-29
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine