1023065356 NPI number — MERCY MEDICAL CENTER OF OSHKOSH, INC.

Table of content: (NPI 1023065356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023065356 NPI number — MERCY MEDICAL CENTER OF OSHKOSH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY MEDICAL CENTER OF OSHKOSH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASCENSION NE WISCONSIN MERCY HOSPITAL, INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023065356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 S OAKWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSHKOSH
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54904-7944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-720-1464
Provider Business Mailing Address Fax Number:
920-720-1728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S OAKWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSHKOSH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54904-7944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-720-1464
Provider Business Practice Location Address Fax Number:
920-720-1728
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSEN
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL PRESIDENT
Authorized Official Telephone Number:
414-465-3721

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  186 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00228 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00228 . This is a "MMC D/B/A THE KENNEDY CENTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32771900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11010100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11010121 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11010126 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41222300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32944600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com