Provider Demographics
NPI:1265977946
Name:ST. JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE 3RD ORDER OF ST F
Entity type:Organization
Organization Name:ST. JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE 3RD ORDER OF ST F
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-717-7200
Mailing Address - Street 1:2661 COUNTY HIGHWAY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5407
Mailing Address - Country:US
Mailing Address - Phone:715-723-1811
Mailing Address - Fax:
Practice Address - Street 1:950 W CLAIREMONT AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6192
Practice Address - Country:US
Practice Address - Phone:715-717-4395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI520017Medicare Oscar/Certification
WI000210Medicare PIN
WI000210Medicare PIN