1750482022 NPI number — CHILDREN'S HOSPITAL OF WISCONSIN, INC.

Table of content: (NPI 1750482022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750482022 NPI number — CHILDREN'S HOSPITAL OF WISCONSIN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HOSPITAL OF WISCONSIN, 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:
Provider Other Organization Name Type Code:
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:
1750482022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1997
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53201-1997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-266-2000
Provider Business Mailing Address Fax Number:
414-266-6409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-266-2000
Provider Business Practice Location Address Fax Number:
414-266-6409
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICCA
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP REVENUE CYCLE
Authorized Official Telephone Number:
414-266-2511

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  135 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 135 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 135 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC2000X , with the licence number: 135 , 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: 119026105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33461 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01509640 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00095382 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00435179X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01700160 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100037470A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6014253 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP43461 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11019700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30-4655055 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013436506 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0944108 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D0927520-00 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11530400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40-4655064 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01 86806201 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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