Provider Demographics
NPI:1184621211
Name:SSM HEALTH CARE OF WISCONSIN, INC.
Entity type:Organization
Organization Name:SSM HEALTH CARE OF WISCONSIN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:2005-07-05
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 275N00000X
WI71282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390806393OtherINS PROVIDER NUMBER
WI5389107OtherPHYSICIANS PLUS PROVIDER
WI11022900Medicaid
WI5283846OtherMEDICA PROVIDER NUMBER
WI67OtherDEANCARE PROVIDER NUMBER
WIA5371501OtherJOHN DEERE PROVIDER NUMBE
WI39080639301OtherUNITY PROVIDER NUMBER
WI390806393026OtherBLUE CROSS PROVIDER NUMBE
WI5283846OtherMEDICA PROVIDER NUMBER
WIA5371501OtherJOHN DEERE PROVIDER NUMBE
WI5389107OtherPHYSICIANS PLUS PROVIDER