Healthcare Provider Details

I. General information

NPI: 1740747559
Provider Name (Legal Business Name): COLUMBIA ST MARY'S HOSPITAL OZAUKEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

IV. Provider business mailing address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7388
  • Fax:
Mailing address:
  • Phone: 262-243-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HANSELMAN
Title or Position: CFO
Credential:
Phone: 414-465-3000