Organization
SSM HEALTH CARE OF WISCONSIN, INC.
Active
Organization
SSM HEALTH CARE OF WISCONSIN, INC.
Active
Other names
St Clare Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH R MINERATH (SYSTEM DIRECTOR - GOV'T REIMB.)
(608) 445-2411
Entity
Organization
Contact information
Practice address
1600 JEFFERSON ST, BARABOO, WI 53913-1542
(608) 356-1400
Mailing address
1802 W BELTLINE HWY, MADISON, WI 53713-2334
(608) 217-8446
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009390
PHYS PLUS PROV #
WI
05
—
11022800
—
WI
01
—
391023846
COMMERCIAL INS PROV #
WI
01
—
391023846028
BLUE CROSS PROV #
WI
01
—
572292
DEANCARE VENDOR #
WI
Enumeration date
11/08/2005
Last updated
01/04/2023
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