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General NPI Number Information
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NPI Number | 1376582775
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Entity Type | Organization
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Legal Business Name | COLUMBIA ST MARY'S HOSPITAL OZAUKEE, INC.
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 13111 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53097-2416
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Country | US
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Telephone | 262-243-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 13111 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53097-2416
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Country | US
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Telephone | 262-243-7300
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MATTHEW HANSELMAN
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Credential |
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Telephone | 414-465-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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