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General NPI Number Information
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NPI Number | 1033152939
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Entity Type | Organization
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Legal Business Name | SSM HEALTH CARE OF WISCONSIN,INC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 2840 INDEX RD
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City | FITCHBURG
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State | WI
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Zip | 53713-3117
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Country | US
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Telephone | 608-229-7222
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Fax | 608-229-7116
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Provider Business Mailing Address
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Address Line | 700 S PARK ST
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City | MADISON
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State | WI
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Zip | 53715-1830
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Country | US
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Telephone | 608-251-6100
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Fax | 608-258-5221
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Authorized Official
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Title or Position | REGIONAL PRESIDENT/CEO
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Name | MARY STARMANN-HARRISON
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Credential |
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Telephone | 608-258-6121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 71
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License Number State | WI
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