Healthcare Provider Details

I. General information

NPI: 1215945456
Provider Name (Legal Business Name): COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 N PORT WASHINGTON RD
GLENDALE WI
53217-3921
US

IV. Provider business mailing address

PO BOX 773380
CHICAGO IL
60677-3380
US

V. Phone/Fax

Practice location:
  • Phone: 414-270-8100
  • Fax:
Mailing address:
  • Phone: 414-585-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUSAN DWYER
Title or Position: CFO
Credential:
Phone: 414-465-3093