Healthcare Provider Details

I. General information

NPI: 1710391776
Provider Name (Legal Business Name): SSM HEALTH CARE OF WISCONSIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 11/27/2023
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:
Mailing address:
  • Phone: 608-251-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

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