Provider Demographics
NPI:1336120401
Name:SSM HEALTH CARE OF WISCONSIN INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN INC
Other - Org Name:CRNA SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:SYSTEM DIRECTOR - GOV'T REIMB.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MINERATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-445-2411
Mailing Address - Street 1:1802 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-445-2411
Mailing Address - Fax:
Practice Address - Street 1:707 14TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1539
Practice Address - Country:US
Practice Address - Phone:608-356-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH ST CLARE HOSPITAL - BARABOO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-07
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI551896OtherDEANCARE PROV #
WI391023846OtherCOMMERCIAL INS PROV #
WI1009390OtherPHYS PLUS PROV #
WI391023846028OtherBLUE CROSS PROV #
WI43418200Medicaid
WI391023846028OtherBLUE CROSS PROV #
WI43418200Medicaid