ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC - NPI 1043478324

Q: What is Ascension Medical Group-Fox Valley Wisconsin, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

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About Ascension Medical Group-fox Valley Wisconsin, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC (NPI 1043478324), doing business as Ascension Medical Group, is a healthcare organization registered as a multi-specialty in Little Chute, Wisconsin and active in the NPI registry since May 2008. The organization holds a CLIA Waiver certificate valid through October 21, 2027 and lists David Jirovec, Sr Finance Director - Medical Group, as its authorized official.

NPPES Registry Identity

NPI1043478324

Entity TypeOrganization

Primary Taxonomy261QM1300X

Legal Business NameASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC

Location Address200 PATRIOT DRLittle Chute, WI 54140

Mailing Address200 Patriot DrLittle Chute, WI 54140-1184 · (920) 738-2000

Phone(920) 687-2800

Organization SubpartNo

Authorized OfficialDavid JirovecSr Finance Director - Medical Group · (715) 347-6655

Enumeration DateMay 23, 2008

Last NPPES UpdateMay 19, 20266 updates tracked since enumeration

NPPES CertifiedMay 19, 2026

✔ NPI 1043478324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM1300X

200 PATRIOT DR, Little Chute, WI 54140

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Other Names 1

Doing Business AsAscension Medical Group

Other Identifiers 1

Medicaid32752000WI

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0394473

Ascension Medical Group- Fox Valley Wisconsin Inc D/B/A Ascension Medical Group · Little Chute, WI

Active · expires Oct 21, 2027

CLIA Number52D0394473

Laboratory TypePhysician Office

Certificate Effective DateOctober 22, 2025

Certificate Expiration DateOctober 21, 2027

Laboratory DirectorDr. David Dedrick

Laboratory Phone(920) 687-2830

Laboratory LocationAscension Medical Group- Fox Valley Wisconsin Inc D/B/A Ascension Medical Group200 Patriot Dr, Little Chute, WI 54140

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACK R MEYER MD

Family Medicine