Provider Demographics
NPI:1003258435
Name:SSM HEALTH CARE OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN, INC.
Other - Org Name:SSM HEALTH ST. MARY'S HOSPITAL - JANESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIR OF GOV REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINERATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-258-6891
Mailing Address - Street 1:3400 E RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2344
Mailing Address - Country:US
Mailing Address - Phone:608-373-8000
Mailing Address - Fax:608-314-8878
Practice Address - Street 1:3400 E RACINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2344
Practice Address - Country:US
Practice Address - Phone:608-373-8000
Practice Address - Fax:608-314-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI318332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies