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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