Provider Demographics
NPI:1275515991
Name:ST JOSEPHS HOSPITAL OF MARSHFIELD INC
Entity Type:Organization
Organization Name:ST JOSEPHS HOSPITAL OF MARSHFIELD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-387-7856
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 1:1041B HILL ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5221
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:2005-11-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42054000Medicaid
WI42054000Medicaid