Provider Demographics
NPI:1972591410
Name:ST. JOSEPH'S HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:ST. JOSEPH'S HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-489-8103
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634-0527
Mailing Address - Country:US
Mailing Address - Phone:608-489-8000
Mailing Address - Fax:608-489-8181
Practice Address - Street 1:400 WATER AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634-9054
Practice Address - Country:US
Practice Address - Phone:608-489-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
WI1005282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11007400Medicaid
WIW002642OtherCHAMPUS
WI11007410Medicaid
WI5919HJOOtherATRIUM
WI210453OtherDEAN HEALTH PLAN
MN5919HJOOtherBCBS MN
MN5919HJOOtherBCBS MN
WI0000000429Medicare Oscar/Certification
WI210453OtherDEAN HEALTH PLAN
WI521304Medicare Oscar/Certification
WI528540Medicare Oscar/Certification
WI0000015145Medicare Oscar/Certification