Provider Demographics
NPI:1487773255
Name:ASCEND HEALTH
Entity type:Organization
Organization Name:ASCEND HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUERLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-884-1989
Mailing Address - Street 1:550 N. MILITARY AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303
Mailing Address - Country:US
Mailing Address - Phone:920-884-1989
Mailing Address - Fax:920-884-8120
Practice Address - Street 1:550 N. MILITARY AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-884-1989
Practice Address - Fax:920-884-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30743-020146N00000X
WI1064023146N00000X
WIS81585363AM0700X
WI2948-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174685598OtherNPI
WI1245230564OtherNPI
WI1093715351OtherNPI
WI000106001Medicare PIN
WIU42585Medicare UPIN
WI000506001Medicare ID - Type Unspecified
WIE50909Medicare UPIN
WI1245230564OtherNPI
WIS81585Medicare UPIN
WI000106001Medicare ID - Type Unspecified