Provider Demographics
NPI:1649210030
Name:SSM HEALTH CARE OF WISCONSIN, INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN, INC
Other - Org Name:ST. MARY'S CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-845-0580
Mailing Address - Street 1:3401 MAPLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5013
Mailing Address - Country:US
Mailing Address - Phone:608-845-1000
Mailing Address - Fax:608-845-1001
Practice Address - Street 1:3401 MAPLE GROVE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-5013
Practice Address - Country:US
Practice Address - Phone:608-845-1000
Practice Address - Fax:608-845-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3101314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20184500Medicaid
WI=========OtherOTHER INS NURS HOME PROV
WI525276Medicare Oscar/Certification