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General NPI Number Information
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NPI Number | 1730126392
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Entity Type | Organization
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Legal Business Name | ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 101 MAIN ST
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City | NEENAH
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State | WI
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Zip | 54956-2570
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Country | US
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Telephone | 920-727-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MAIN ST
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City | NEENAH
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State | WI
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Zip | 54956-2570
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Country | US
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Telephone | 920-727-4200
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Fax |
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Authorized Official
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Title or Position | VP-FINANCE
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Name | J. BRYAN FISSEL
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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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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