Provider Demographics
NPI:1114909710
Name:SAINT JOSEPH'S HOSPITAL OF MARSHFIELD, INC
Entity Type:Organization
Organization Name:SAINT JOSEPH'S HOSPITAL OF MARSHFIELD, INC
Other - Org Name:MINISTRY SPIRIT MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STANDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-465-3720
Mailing Address - Street 1:611 ST JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1832
Mailing Address - Country:US
Mailing Address - Phone:715-387-1713
Mailing Address - Fax:715-387-7434
Practice Address - Street 1:611 SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1832
Practice Address - Country:US
Practice Address - Phone:715-387-1713
Practice Address - Fax:715-387-7434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOSEPH'S HOSPITAL OF MARSHFIELD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-18
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60013473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41351800Medicaid