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General NPI Number Information
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NPI Number | 1962507228
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL OF WISCONSIN, INC.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 6308 8TH AVE SIXTH FLOOR
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City | KENOSHA
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State | WI
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Zip | 53143-5031
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Country | US
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Telephone | 262-656-2261
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Fax | 262-653-5751
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Provider Business Mailing Address
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Address Line | PO BOX 1997
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City | MILWAUKEE
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State | WI
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Zip | 53201-1997
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Country | US
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Telephone | 414-266-2000
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Fax | 414-266-6409
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Authorized Official
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Title or Position | CFO/TREASURER
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Name | MR. WELDON W GAGE
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Credential |
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Telephone | 414-266-6401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 1003
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License Number State | WI
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