Healthcare Provider Details

I. General information

NPI: 1386641207
Provider Name (Legal Business Name): SSM HEALTH CARE OF WISCONSIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 14TH ST
BARABOO WI
53913-1539
US

IV. Provider business mailing address

707 14TH ST
BARABOO WI
53913-1539
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-1400
  • Fax:
Mailing address:
  • Phone: 608-356-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number65
License Number StateWI

VIII. Authorized Official

Name: JOSEPH R MINERATH
Title or Position: SYSTEM DIRECTOR GOV'T REIMBURSEMENT
Credential:
Phone: 608-445-2411