Healthcare Provider Details

I. General information

NPI: 1013548833
Provider Name (Legal Business Name): ASCENSION WISCONSIN SURGERY CENTER-MOUNT PLEASANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 WASHINGTON AVE STE 200
MOUNT PLEASANT WI
53177-1604
US

IV. Provider business mailing address

10180 WASHINGTON AVE STE 200
MOUNT PLEASANT WI
53177-1604
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-7590
  • Fax:
Mailing address:
  • Phone: 262-687-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

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