Provider Demographics
NPI:1053343442
Name:ASCENSION WISCONSIN LABORATORIES, INC
Entity type:Organization
Organization Name:ASCENSION WISCONSIN LABORATORIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3736
Mailing Address - Street 1:2323 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4508
Mailing Address - Country:US
Mailing Address - Phone:414-585-1424
Mailing Address - Fax:
Practice Address - Street 1:2323 N LAKE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-585-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32913200Medicaid
WI303142OtherMANAGED HEALTH PROV NUMBE
WI2131232001OtherUHC MEDICAID PROVIDER NUM
WI8591085OtherAETNA PROV NUMBER
WI303142OtherMANAGED HEALTH PROV NUMBE
WI=========011OtherBLUE CROSS/BLUE SHIELD PR
WI32913200Medicaid
WI303142OtherMANAGED HEALTH PROV NUMBE