Healthcare Provider Details

I. General information

NPI: 1376541748
Provider Name (Legal Business Name): ASCENSION CALUMET HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 MEMORIAL DR
CHILTON WI
53014-1568
US

IV. Provider business mailing address

614 MEMORIAL DR
CHILTON WI
53014-1568
US

V. Phone/Fax

Practice location:
  • Phone: 920-849-2386
  • Fax: 920-849-1801
Mailing address:
  • Phone: 920-849-2386
  • Fax: 920-849-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1020
License Number StateWI

VIII. Authorized Official

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