Provider Demographics
NPI:1932719580
Name:WHEATON FRANCISCAN HEALTHCARE SOUTHEAST WISCONSIN, INC
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE SOUTHEAST WISCONSIN, INC
Other - Org Name:ASCENSION WISCONSIN EMPLOYER SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3000
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:715-295-5289
Practice Address - Street 1:2333 NORTHWESTERN AVE STE 115
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-2520
Practice Address - Country:US
Practice Address - Phone:262-635-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine