Provider Demographics
NPI:1104031798
Name:ST. JOSEPH'S HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ST. JOSEPH'S HEALTH SERVICES, INC.
Other - Org Name:ST. JOSEPH'S HEALTH SERVICES - HILLSBORO CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-489-8103
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634-0527
Mailing Address - Country:US
Mailing Address - Phone:608-489-8280
Mailing Address - Fax:608-489-8189
Practice Address - Street 1:400 WATER AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634-9054
Practice Address - Country:US
Practice Address - Phone:608-489-8280
Practice Address - Fax:608-489-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI78B97J0OtherATRIUM COMMERCIAL
WIP10OtherDEAN HEALTH PLAN
WI11007410Medicaid
WI=========010OtherANTHEM BCBS
WI78B97J0OtherATRIUM COMMERCIAL
WI=========010OtherANTHEM BCBS