Healthcare Provider Details

I. General information

NPI: 1316601487
Provider Name (Legal Business Name): ASCENSION SACRED HEART-ST. MARY'S HOSPITALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 PINE ST
STANLEY WI
54768-1297
US

IV. Provider business mailing address

29980 NETWORK PL
CHICAGO IL
60673-1299
US

V. Phone/Fax

Practice location:
  • Phone: 715-355-9573
  • Fax:
Mailing address:
  • Phone: 715-847-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SIDNEY CHARLES SCZYGELSKI
Title or Position: VPF
Credential:
Phone: 715-847-2250