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1730160011

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
1	207P00000X	Emergency Medicine Physician
2	208000000X	Pediatrics Physician
3	208M00000X	Hospitalist Physician
4	227900000X	Registered Respiratory Therapist
5	363A00000X	Physician Assistant
6	363LA2100X	Acute Care Nurse Practitioner
7	363LF0000X	Family Nurse Practitioner
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
9	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	391023846	OTHER	WI	COMMERCIAL INS PROV #
3	391023846028	OTHER	WI	BLUE CROSS PROV #
4	1009390	OTHER	WI	PHYS PLUS PROV #

General Provider Information

NPI Number	:	1730160011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSM HEALTH CARE OF WISCONSIN INC

Provider Business Mailing Address
First Line	:	707 14TH ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-1539
Country	:	US
Telephone Number	:	608-356-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 14TH ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-1539
Country	:	US
Telephone Number	:	608-356-1400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	TROY WALKER
Credential	:
Telephone Number	:	608-356-1423

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	01/17/2024

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

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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