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NPI Code Detail

MEDICARE: SSM HEALTH CARE OF WISCONSIN, INC.

MEDICARE: SSM HEALTH CARE OF WISCONSIN, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy8247-42WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22115167OTHERPK

General Provider Information

NPI Number : 1407932536
Entity Type Code : Organization
Provider Name (Legal Business Name) : SSM HEALTH CARE OF WISCONSIN, INC.
Provider Business Mailing Address
First Line : 3401 MAPLE GROVE DR
Second Line :
City : MADISON
State : WI
Zip : 53719-5013
Country : US
Telephone Number : 608-845-0447
Fax Number : 608-845-0449
Provider Business Practice Location Address
First Line : 3401 MAPLE GROVE DR
Second Line :
City : MADISON
State : WI
Zip : 53719-5013
Country : US
Telephone Number : 608-845-0447
Fax Number : 608-845-0449
Authorized Official
Title or Position : PHARMACIST
Name : AUDREY RUFENACHT
Credential : PHARMD
Telephone Number : 608-845-0447
Provider Enumeration Date : 10/31/2006
Last Update Date : 10/25/2021

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Practice Location Address:
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1780889600 — KELLI M NEAL COTA
Practice Location Address:
3401 MAPLE GROVE DR , ST MARYS CARE CENTER
MADISON, WI
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1497922058 — BECKY M WHITING OTR
Practice Location Address:
3401 MAPLE GROVE DR , ST MARYS CARE CENTER
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Practice Fax: 608-845-1001

Directions to “SSM HEALTH CARE OF WISCONSIN, INC. ” Practice Location

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