Provider Demographics
NPI:1932719580
Name:ASCENSION MEDICAL GROUP-SOUTHEAST WISCONSIN INC
Entity type:Organization
Organization Name:ASCENSION MEDICAL GROUP-SOUTHEAST WISCONSIN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP ASCENSION WI EMPLOYER SOLUTIONS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3600
Mailing Address - Street 1:2700 W 9TH AVE STE 101A
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7201
Mailing Address - Country:US
Mailing Address - Phone:414-465-3600
Mailing Address - Fax:
Practice Address - Street 1:2333 NORTHWESTERN AVE STE 115
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-2520
Practice Address - Country:US
Practice Address - Phone:262-635-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION MEDICAL GROUP-SOUTHEAST WISCONSIN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-07
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine