Provider Demographics
NPI:1750594297
Name:ASCENSION SE WISCONSIN HOSPITAL, INC
Entity type:Organization
Organization Name:ASCENSION SE WISCONSIN HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3736
Mailing Address - Street 1:3070 N 51ST ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1645
Mailing Address - Country:US
Mailing Address - Phone:414-445-6520
Mailing Address - Fax:
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE 601
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-445-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION SE WISCONSIN HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-08
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21308800Medicaid
WI21308800Medicaid
WI000001389Medicare ID - Type UnspecifiedMEDICARE NUMBER