Healthcare Provider Details

I. General information

NPI: 1881780302
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SECOND ST
NEENAH WI
54956
US

IV. Provider business mailing address

PO BOX 1997
MILWAUKEE WI
53201-1997
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-7900
  • Fax: 920-969-7997
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 Number1005
License Number StateWI

VIII. Authorized Official

Name: MR. MARC CADIEUX
Title or Position: CORPORATE VP AND CFO
Credential:
Phone: 414-266-6226