Provider Demographics
NPI:1285020552
Name:SSM HEALTH CARE OF WISCONSIN INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN INC
Other - Org Name:REFERENCE LAB
Other - Org Type:Other Name
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?:Yes
Parent Organization LBN:SSM HEALTH ST MARYS HOSPITAL - JANESVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI318291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory