Organization
ASCENSION WISCONSIN LABORATORIES, INC
Active
Other names
Ascension Wisconsin Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MCCULLOUGH (CFO)
(414) 465-3736
Entity
Organization
Contact information
Practice address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 585-1424
Mailing address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 585-1424
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2131232001
UHC MEDICAID PROVIDER NUM
WI
01
—
303142
MANAGED HEALTH PROV NUMBE
WI
05
—
32913200
—
WI
01
—
8591085
AETNA PROV NUMBER
WI
Enumeration date
07/07/2006
Last updated
01/07/2025
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