Provider Demographics
NPI:1386688240
Name:SSM HEALTH CARE OF WISCONSIN, INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN, INC
Other - Org Name:SSM HEALTH ST MARY'S HOSPITAL - MADISON
Other - Org Type:Doing Business As
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 1:700 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-258-6891
Mailing Address - Fax:608-227-0112
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-251-6100
Practice Address - Fax:608-258-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV39080639301OtherUNITY PROVIDER NUMBER
WI390806393026OtherBLUE CROSS PROVIDER NUMBE
WI5283846OtherMEDICA PROVIDER NUMBER
WI390806393OtherOTHER INSURANCE PROVIDER
WI5389107OtherPHYSICIANS PLUS PROVIDER
WI67OtherDEANCARE PROVIDER NUMBER
WIA5371501OtherJOHN DEERE PROVIDER NUMBE
WI11022900OtherWI MEDICAID PROVIDER NUMB
WI390806393026OtherBLUE CROSS PROVIDER NUMBE
WIA5371501OtherJOHN DEERE PROVIDER NUMBE
WIA5371501OtherJOHN DEERE PROVIDER NUMBE