Provider Demographics
NPI:1265453229
Name:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:CADIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-6226
Mailing Address - Street 1:PO BOX 1997
Mailing Address - Street 2:MS 900 ROSALIE O'MEARA
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-1997
Mailing Address - Country:US
Mailing Address - Phone:414-266-2000
Mailing Address - Fax:414-266-1894
Practice Address - Street 1:9000 W. WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-1893
Practice Address - Fax:414-266-1894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
WI8244-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2110046OtherPK
WI11019700Medicaid
WI33265100Medicaid