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General NPI Number Information
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NPI Number | 1932719580
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Entity Type | Organization
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Legal Business Name | ASCENSION MEDICAL GROUP-SOUTHEAST WISCONSIN INC
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2333 NORTHWESTERN AVE STE 115
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City | RACINE
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State | WI
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Zip | 53404-2520
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Country | US
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Telephone | 262-635-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 W 9TH AVE STE 101A
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City | OSHKOSH
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State | WI
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Zip | 54904-7201
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Country | US
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Telephone | 414-465-3600
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Fax |
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Authorized Official
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Title or Position | VP ASCENSION WI EMPLOYER SOLUTIONS
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Name | DONNA OWENS
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Credential |
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Telephone | 414-465-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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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 | 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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