Provider Demographics
NPI:1053392845
Name:SSM HEALTH CARE OF WISCONSIN, INC.
Entity type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR - GOV'T REIMB.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MINERATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-445-2411
Mailing Address - Street 1:1802 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-217-8446
Mailing Address - Fax:
Practice Address - Street 1:1600 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1542
Practice Address - Country:US
Practice Address - Phone:608-356-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11022800Medicaid
WI572292OtherDEANCARE VENDOR #
WI391023846OtherCOMMERCIAL INS PROV #
WI1009390OtherPHYS PLUS PROV #
WI391023846028OtherBLUE CROSS PROV #
WI391023846028OtherBLUE CROSS PROV #
WI391023846028OtherBLUE CROSS PROV #