Healthcare Provider Details

I. General information

NPI: 1407803638
Provider Name (Legal Business Name): ASCENSION NE WISCONSIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S ONEIDA ST
APPLETON WI
54915
US

IV. Provider business mailing address

1506 S ONEIDA ST
APPLETON WI
54915-1305
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-1464
  • Fax: 920-720-1728
Mailing address:
  • Phone: 920-720-1464
  • Fax: 920-720-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number88
License Number StateWI

VIII. Authorized Official

Name: MICHAEL MCCULLOUGH
Title or Position: CFO
Credential:
Phone: 414-465-3736