ST MARY'S HOSPITAL MEDICAL CENTER (NPI# 1790071637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790071637 |
| Entity Type | Organization |
| Organization Name | ST MARY'S HOSPITAL MEDICAL CENTER |
| Other Organization Name | ST MARY'S SUN PRAIRIE EMERGENCY CENTER |
| Practice Address |
2840 Okeeffe Ave Sun Prairie WI 53590-7077 |
| Mailing Address |
6501 City West Pkwy Eden Prairie MN 55344-3248 |
| Practice Telephone | 6082298484 |
| Mailing Telephone | 9526532525 |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-06-20 |
| Authorized Official Name | BOB FALSEY (DIRECTOR OF PHARMACY) |
| Authorized Official Telephone | 9526532525 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST MARY'S HOSPITAL MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Other Name | Type Code |
|---|---|
| St Mary's Sun Prairie Emergency Center | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST MARY'S HOSPITAL MEDICAL CENTER | 700 S Park St, Madison, WI 53715-1849 |
| Street Address |
2840 OKEEFFE AVE |
| City | SUN PRAIRIE |
| State | WI |
| Zip Code | 53590-7077 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194280529 | Kasi Lucas Schroeder | Chiropractor | 110 N Grand Ave, Suite 4, Sun Prairie, WI 53590 | 2019-02-11 |
| 1770053712 | Jamie Engstrom | Psychologist | 3061 Pleasant St, 216, Sun Prairie, WI 53590 | 2018-12-03 |
| 1154837433 | Wisconsin Dental Health, LLC | Dentist | 390 S. Grand Ave, Suite#110, Sun Prairie, WI 53590 | 2017-12-21 |
| 1669981676 | Elizabeth M Gregg | Counselor | 1170 N Bird St, Sun Prairie, WI 53590 | 2017-09-21 |
| 1609298595 | Prairie Lakes Dental | Dentist | 2804 Prairie Lakes Drive, Sun Prairie, WI 53590 | 2014-01-10 |
| 1407297559 | Quality Medical Rides LLC | Non-emergency Medical Transport (VAN) | 2907 Vang Rd, Sun Prairie, WI 53590 | 2013-07-17 |
| 1376892851 | Costco Wholesale Corporation | Pharmacy | 2850 Hoepker Rd, Sun Prairie, WI 53590 | 2012-08-30 |
| 1043454234 | Dean Lewis Drake | Registered Nurse | 7281 County Rd V. V., Sun Prairie, WI 53590 | 2009-05-01 |
| 1679728992 | Dianne Mary Mayr | Registered Nurse | 3181 Nature Dr, Conservancy States Ln, Sun Prairie, WI 53590 | 2008-12-01 |
| 1043462021 | Crown Point Village, LLC | Assisted Living Facility | 881 Liberty Boulevard, Sun Prairie, WI 53590 | 2008-10-21 |
| Find all providers in zip 53590 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477188100 | Froedtert & The Medical College of Wisconsin Community Physicians Inc | Non-Pharmacy Dispensing Site | 635 S 28th St, Milwaukee, WI 53215-1201 | 2020-03-03 |
| 1841845385 | Planned Parenthood of Wisconsin | Non-Pharmacy Dispensing Site | 223 South Main St., Blair, WI 54616 | 2019-08-01 |
| 1982258737 | Planned Parenthood of Wisconsin | Non-Pharmacy Dispensing Site | 919 Hoeschler Dr Ste 100, Sparta, WI 54656-2202 | 2019-07-30 |
| 1780142992 | Froedtert & The Medical College of Wisconsin Community Physicians | Non-Pharmacy Dispensing Site | 11040 N Range Line Rd, Mequon, WI 53092-4930 | 2019-03-06 |
| 1992284087 | Froedtert & The Medical College of Wisconsin Community Physicians | Non-Pharmacy Dispensing Site | 4859 South 60th Street, Greenfield, WI 53220 | 2018-08-09 |
| 1801373378 | Froedtert & The Medical College of Wisconsin Community Physicians | Non-Pharmacy Dispensing Site | 1721 W Canal St, Milwaukee, WI 53233 | 2018-07-26 |
| 1205355500 | Froedtert Health | Non-Pharmacy Dispensing Site | 4850 S 60th St, Greenfield, WI 53220-4616 | 2017-09-18 |
| 1629390729 | Jt Medical Services, Inc. | Non-Pharmacy Dispensing Site | 12855 West Lisbon Road, 2nd Floor, Brookfield, WI 53005 | 2010-02-17 |
| 1013243294 | Barron County Office On Aging | Non-Pharmacy Dispensing Site | 335 E. Monroe Avenue, Room 112, Barron, WI 54812-1478 | 2009-10-23 |
| 1639344138 | Planned Parenthood of Wisconsin | Non-Pharmacy Dispensing Site | 1221 13th Ave, Monroe, WI 53566-2035 | 2008-04-25 |
| Find all providers with the same taxonomy | ||||
| City | SUN PRAIRIE |
| Zip Code | 53590 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.