Healthcare Provider Details

I. General information

NPI: 1831132802
Provider Name (Legal Business Name): SSM HEALTH CARE OF WISCONSIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S. PARK ST.
MADISON WI
53715-1830
US

IV. Provider business mailing address

700 S. PARK ST.
MADISON WI
53715-1830
US

V. Phone/Fax

Practice location:
  • Phone: 608-251-6100
  • Fax: 608-258-5221
Mailing address:
  • Phone: 608-251-6100
  • Fax: 608-258-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number71
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number71
License Number StateWI

VIII. Authorized Official

Name: JOSEPH MINERATH
Title or Position: SYSTEM DIR OF GOV REIMBURSEMENT
Credential:
Phone: 608-258-6891