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General NPI Number Information
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NPI Number | 1922067636
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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 | 03/21/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1414 JEFFERSON ST
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City | BARABOO
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State | WI
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Zip | 53913-1503
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Country | US
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Telephone | 608-356-4838
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Fax | 608-356-5441
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Provider Business Mailing Address
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Address Line | 1414 JEFFERSON ST
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City | BARABOO
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State | WI
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Zip | 53913-1503
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Country | US
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Telephone | 608-356-4838
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Fax | 608-356-5441
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RONNIE E SCHAETZL
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Credential |
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Telephone | 608-356-4838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 3099
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License Number State | WI
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