1104140706 NPI number — PUBLIC HEALTH MADISON AND DANE COUNTY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104140706 NPI number — PUBLIC HEALTH MADISON AND DANE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HEALTH MADISON AND DANE COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104140706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
ROOM 507
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53703-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-266-4821
Provider Business Mailing Address Fax Number:
608-266-4858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
ROOM 507
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53703-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-266-4821
Provider Business Practice Location Address Fax Number:
608-266-4858
Provider Enumeration Date:
03/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCHLENKER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
608-243-0300

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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