| Columbia St Mary's Hospital Ozaukee, Inc. | |
|
13111 N Port Washington Rd Mequon WI 53097-2416 | |
| (262) 243-7300 | |
| Not Available |
| Full Name | Columbia St Mary's Hospital Ozaukee, Inc. |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 13111 N Port Washington Rd, Mequon, Wisconsin |
| Authorized Official Name and Position | Matthew Hanselman (CFO) |
| Authorized Official Contact | 4144653000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia St Mary's Hospital Ozaukee, Inc. 13111 N Port Washington Rd Mequon WI 53097-2416 Ph: (262) 243-7300 | Columbia St Mary's Hospital Ozaukee, Inc. 13111 N Port Washington Rd Mequon WI 53097-2416 Ph: (262) 243-7300 |
| NPI Number | 1376582775 |
|---|---|
| Provider Enumeration Date | 06/05/2006 |
| Last Update Date | 11/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376582775 | NPI | - | NPPES |
| 32869300 | Medicaid | WI | |
| 21262500, 21268700 | Medicaid | WI | |
| 21262700, 21262400 | Medicaid | WI | |
| 21279900 | Medicaid | WI | |
| 32757400, 21262600 | Medicaid | WI | |
| 38997300, 21273300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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