Healthcare Provider Details

I. General information

NPI: 1649080722
Provider Name (Legal Business Name): ASCENSION MEDICAL GROUP-SOUTHEAST WISCONSIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8640 S HOWELL AVE
OAK CREEK WI
53154-2918
US

IV. Provider business mailing address

2700 W 9TH AVE STE 101A
OSHKOSH WI
54904-7201
US

V. Phone/Fax

Practice location:
  • Phone: 414-465-3600
  • Fax:
Mailing address:
  • Phone: 414-465-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA OWENS
Title or Position: VP ASCENSION WI EMPLOYER SOLUTIONS
Credential:
Phone: 262-378-0347