Healthcare Provider Details

I. General information

NPI: 1336120401
Provider Name (Legal Business Name): SSM HEALTH CARE OF WISCONSIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 14TH ST
BARABOO WI
53913-1539
US

IV. Provider business mailing address

1802 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-1400
  • Fax:
Mailing address:
  • Phone: 608-445-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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