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General NPI Number Information
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NPI Number | 1407932536
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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 | 10/31/2006
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 3401 MAPLE GROVE DR
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City | MADISON
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State | WI
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Zip | 53719-5013
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Country | US
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Telephone | 608-845-0447
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Fax | 608-845-0449
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Provider Business Mailing Address
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Address Line | 3401 MAPLE GROVE DR
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City | MADISON
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State | WI
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Zip | 53719-5013
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Country | US
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Telephone | 608-845-0447
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Fax | 608-845-0449
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Authorized Official
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Title or Position | PHARMACIST
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Name | AUDREY RUFENACHT
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Credential | PHARMD
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Telephone | 608-845-0447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 8247-42
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License Number State | WI
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