Provider Demographics
NPI:1144224676
Name:ST JOSEPH'S HOSPITAL OF MARSHFIELD, INC
Entity Type:Organization
Organization Name:ST JOSEPH'S HOSPITAL OF MARSHFIELD, INC
Other - Org Name:SAINT JOSEPH'S HOSPITAL
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 SAINT 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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
WI51282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11009100OtherBADGERCARE
WI11009100Medicaid
WI11009100OtherHRSP
WI11009100Medicaid