Healthcare Provider Details

I. General information

NPI: 1629050232
Provider Name (Legal Business Name): SAINT JOSEPH'S HOSPITAL OF MARSHFIELD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SAINT JOSEPH AVE
MARSHFIELD WI
54449-1832
US

IV. Provider business mailing address

611 ST JOSEPH AVE
MARSHFIELD WI
54449-1832
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-1713
  • Fax: 715-387-7434
Mailing address:
  • Phone: 715-387-1713
  • Fax: 715-387-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number6001347
License Number StateWI

VIII. Authorized Official

Name: DEBRA K STANDRIDGE
Title or Position: REGIONAL PRESIDENT
Credential:
Phone: 414-465-3720