Healthcare Provider Details

I. General information

NPI: 1871656082
Provider Name (Legal Business Name): COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

PO BOX 773380
CHICAGO IL
60677-3380
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-1000
  • Fax:
Mailing address:
  • Phone: 414-585-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number53
License Number StateWI

VIII. Authorized Official

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