Healthcare Provider Details

I. General information

NPI: 1922067636
Provider Name (Legal Business Name): SSM HEALTH CARE OF WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 JEFFERSON ST
BARABOO WI
53913-1503
US

IV. Provider business mailing address

1414 JEFFERSON ST
BARABOO WI
53913-1503
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-4838
  • Fax: 608-356-5441
Mailing address:
  • Phone: 608-356-4838
  • Fax: 608-356-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3099
License Number StateWI

VIII. Authorized Official

Name: RONNIE E SCHAETZL
Title or Position: ADMINISTRATOR
Credential:
Phone: 608-356-4838