Healthcare Provider Details

I. General information

NPI: 1346229697
Provider Name (Legal Business Name): SSM HEALTHCARE OF WI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 11/27/2023
Certification Date:
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 TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number52D0939990
License Number StateWI

VIII. Authorized Official

Name: TROY WALKER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 608-356-1400