Healthcare Provider Details

I. General information

NPI: 1750482022
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/29/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-3518
US

IV. Provider business mailing address

PO BOX 1997
MILWAUKEE WI
53201-1997
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2000
  • Fax: 414-266-6409
Mailing address:
  • Phone: 414-266-2000
  • Fax: 414-266-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number135
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number135
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number135
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number135
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONICA RICCA
Title or Position: VP REVENUE CYCLE
Credential:
Phone: 414-266-2511