Provider Demographics
NPI:1922067636
Name:SSM HEALTH CARE OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN, INC.
Other - Org Name:ST. CLARE MEADOWS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHAETZL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-356-4838
Mailing Address - Street 1:1414 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1503
Mailing Address - Country:US
Mailing Address - Phone:608-356-4838
Mailing Address - Fax:608-356-5441
Practice Address - Street 1:1414 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1503
Practice Address - Country:US
Practice Address - Phone:608-356-4838
Practice Address - Fax:608-356-5441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CLARE MEADOWS CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3099314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20184400Medicaid
647552OtherCOMBINED INSURANCE CO OF
391023846539130001OtherWPS TRICARE FOR LIFE
39117860200OtherUNITY/COMMUNITY HMO
391023846036OtherBLUE CROSS BLUE SHIELD WI
556910OtherDEAN HEALTH PLAN
391023846539130001OtherWPS TRICARE FOR LIFE
T=========OtherBLUE CROSS BLUE SHIELD IL
=========OtherAMERICAN REPUBLIC INS CO
39117860200OtherUNITY/COMMUNITY HMO
556910OtherDEAN HEALTH PLAN
647552OtherCOMBINED INSURANCE CO OF
=========OtherUNITED HEALTHCARE SERVICE
=========OtherAETNA
39117860200OtherUNITY/COMMUNITY HMO