MEDICARE: SSM HEALTH CARE OF WISCONSIN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	572292	OTHER	WI	DEANCARE VENDOR #
3	391023846	OTHER	WI	COMMERCIAL INS PROV #
4	1009390	OTHER	WI	PHYS PLUS PROV #
5	391023846028	OTHER	WI	BLUE CROSS PROV #

General Provider Information

NPI Number	:	1053392845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSM HEALTH CARE OF WISCONSIN, INC.

Provider Business Mailing Address
First Line	:	1802 W BELTLINE HWY
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53713-2334
Country	:	US
Telephone Number	:	608-217-8446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 JEFFERSON ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-1542
Country	:	US
Telephone Number	:	608-356-1400
Fax Number	:

Authorized Official
Title or Position	:	SYSTEM DIRECTOR - GOV'T REIMB.
Name	:	JOSEPH R MINERATH
Credential	:
Telephone Number	:	608-445-2411

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	01/04/2023

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Directions to “SSM HEALTH CARE OF WISCONSIN, INC. ” Practice Location

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