Provider Demographics
NPI:1831132802
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:608-251-6100
Mailing Address - Fax:608-258-5221
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:2006-06-14
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71332B00000X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39080639301OtherUNITY PROVIDER NUMBER
WI390806393026OtherBLUE CROSS PROVIDER NUMBE
WI67OtherDEANCARE PROVIDER NUMBER
WIA5371501OtherJOHN DEERE PROVIDER NUMBE
WI33243400Medicaid
5112254OtherNAVITUS
WI5112254Medicaid
WI5283846OtherMEDICA PROVIDER NUMBER
WI5389107OtherPHYSICIANS PLUS PROVIDER
WI390806393OtherOTHER INS PROVIDER NUMBER
WI390806393OtherOTHER INS PROVIDER NUMBER
WI5283846OtherMEDICA PROVIDER NUMBER
WI5112254Medicaid