Provider Demographics
NPI:1881607463
Name:ST. JOSEPH'S HEALTH SERVICES, INC
Entity type:Organization
Organization Name:ST. JOSEPH'S HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-489-8103
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634-0527
Mailing Address - Country:US
Mailing Address - Phone:608-489-8000
Mailing Address - Fax:608-489-8181
Practice Address - Street 1:301 RAILROAD RD
Practice Address - Street 2:
Practice Address - City:WONEWOC
Practice Address - State:WI
Practice Address - Zip Code:53968-9425
Practice Address - Country:US
Practice Address - Phone:608-464-3575
Practice Address - Fax:608-464-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP10OtherDEAN HEALTH PLAN
WI78B97JOOtherATRIUM
MN78B97JOOtherBCBS MINNESOTA
WI100019417Medicaid
WI=========03OtherUNITY HEALTH PLAN
WIP10OtherDEAN HEALTH PLAN
WI0000031005Medicare Oscar/Certification
MN78B97JOOtherBCBS MINNESOTA