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DSH520136AW Ascension SE Wisconsin Hospital, Inc. (Active)
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Main Details
Name
Ascension SE Wisconsin Hospital, Inc.
Subdivision Name
Elmbrook MAMMOGRAPHY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH520136AW
Medicare Provider Number
520136
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/8/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/9/2013
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Ascension Elmbrook Memorial Hospital
Kurt Ronald Schley, President
(262) 785-2239
Primary Contact
Ascension WI
Cescilly Smith-Jenkins, 340B Program Director – Wisconsin
(414) 522-7533
Addresses
Street Address
19305 WEST NORTH AVENUE
Brookfield, WI 53045
Billing Address
Ascension SE Wisconsin Hospital - Elmbrook Campus
19333 West North Avenue
Brookfield, WI 53045
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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