Basic Information
| Provider Information | |||||||||
| NPI: | 1508872409 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASCENSION NE WISCONSIN, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASCENSION NE WISCONSIN-MERCY CAMPUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S OAKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | OSHKOSH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549047944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207201464 | ||||||||
| FaxNumber: | 9207201728 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S OAKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | OSHKOSH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207201464 | ||||||||
| FaxNumber: | 9207201728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HANSELMAN | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4144653000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 52T009 | 01 | WI | PART A PTAN | OTHER |