Provider Demographics
NPI:1386641207
Name:SSM HEALTH CARE OF WISCONSIN INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN INC
Other - Org Name:SSM HEALTH ST CLARE HOSPITAL-BARABOO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-356-1400
Mailing Address - Street 1:707 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1539
Mailing Address - Country:US
Mailing Address - Phone:608-356-1400
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
WI65282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1309280001OtherDMERC PROV #
WI70OtherDEANCARE HMO VENDOR #
WI391023846028OtherBLUE CROSS/BLUE SHIELD
WI391023846OtherFTN-COMMERCIAL PAYERS
WI11022800Medicaid
IL391023846001Medicaid
WI1009390OtherPHYSICIANS PLUS PROV #
WI520057Medicare Oscar/Certification
WI11022800Medicaid