Basic Information
| Provider Information | |||||||||
| NPI: | 1225635592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION WISCONSIN EMERUS MENOMONEE FALLS, LLC | ||||||||
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| OtherOrganizationName: | ASCENSION WISCONSIN HOSPITAL - WAUKESHA CAMPUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8686 NEW TRAILS DR, STE 100 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773811176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136371146 | ||||||||
| FaxNumber: | 2812923585 | ||||||||
| Practice Location | |||||||||
| Address1: | 2325 FOX RUN BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531886602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627323865 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2020 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCHMERBECK | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7136371145 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASCENSION WISCONSIN EMERUS MENOMONEE FALLS, LLC | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100197944 | 05 | WI | MEDICAID |