Provider Demographics
NPI:1023065356
Name:MERCY MEDICAL CENTER OF OSHKOSH, INC.
Entity type:Organization
Organization Name:MERCY MEDICAL CENTER OF OSHKOSH, 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 1:500 S OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7944
Mailing Address - Country:US
Mailing Address - Phone:920-720-1464
Mailing Address - Fax:920-720-1728
Practice Address - Street 1:500 S OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7944
Practice Address - Country:US
Practice Address - Phone:920-720-1464
Practice Address - Fax:920-720-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI186282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
00228OtherMEDICARE PART B
00228OtherMMC D/B/A THE KENNEDY CENTER
WI32771900Medicaid
WI11010100Medicaid
WI11010121Medicaid
WI11010126Medicaid
WI41222300Medicaid
WI32944600Medicaid
WI71545Medicare ID - Type UnspecifiedMMC DBA FOLEY SURGERY
WI11010126Medicaid
WI71140Medicare ID - Type UnspecifiedMMC DBA MATHISON/WEBER
WI71075Medicare ID - Type UnspecifiedMMC DBA CAULEY/WRIGHT/TUV
WI11010100Medicaid