Organization
SSM HEALTH CARE OF WISCONSIN,INC
Active
Other names
St. Mary's Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MARY STARMANN-HARRISON (REGIONAL PRESIDENT/CEO)
(608) 258-6121
Entity
Organization
Contact information
Practice address
2840 INDEX RD, FITCHBURG, WI 53713-3117
(608) 229-7222
(608) 229-7116
Mailing address
700 S PARK ST, MADISON, WI 53715-1830
(608) 251-6100
(608) 258-5221
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
71
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11022900
—
WI
01
—
390806393
OTHER INS PROVIDER NUMBER
WI
01
—
39080639301
UNITY PROVIDER NUMBER
WI
01
—
390806393026
BLUE CROSS PROV NUMBER
WI
01
—
5283846
MEDICA PROVIDER NUMBER
WI
01
—
5389107
PHYSICIANS PLUS PROVIDER
WI
01
—
67
DEANCARE PROVIDER NUMBER
WI
01
—
A5371501
JOHN DEERE PROVIDER NUMBE
WI
Enumeration date
06/14/2006
Last updated
09/14/2009
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