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PED523300-92 CHILDREN'S HOSPITAL OF WISCONSIN, INC. (Active)
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Main Details
Name
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Subdivision Name
Children's Hospital of Wisconsin Clinics Inc / Kenosha Clinic Dermatology (CC9328) - Dermatology
Type
Children's Hospital
Rural
No
340B ID
PED523300-92
Medicare Provider Number
523300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/9/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/7/2023
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Children's Hospital of Wisconsin
Scott Turner, COO CHW and EVP CHHS
(414) 266-2648
Primary Contact
Children's Wisconsin
Megan Elizabeth Ose, Director of Pharmacy Services
(414) 266-5773
Addresses
Street Address
6809 122ND AVENUE
KENOSHA, WI 53142
Billing Address
Children's Hospital of Wisconsin, Inc
9000 W Wisconsin Avenue
Milwaukee, WI 53226
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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