Healthcare Provider Details

I. General information

NPI: 1487759817
Provider Name (Legal Business Name): WAUKESHA HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 AMERICAN AVE
WAUKESHA WI
53188-5031
US

IV. Provider business mailing address

PO BOX 649
WAUKESHA WI
53187-0649
US

V. Phone/Fax

Practice location:
  • Phone: 252-928-7600
  • Fax: 262-928-1947
Mailing address:
  • Phone: 262-650-4122
  • Fax: 262-544-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number6694042
License Number StateWI

VIII. Authorized Official

Name: SUSAN A EDWARDS
Title or Position: CEO
Credential:
Phone: 262-928-2263