1104918325 NPI number — UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY

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 1104918325 NPI number — UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY
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:
6
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:
1104918325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 HIGHLAND AVE
Provider Second Line Business Mailing Address:
PHARMACY F6/133
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53792-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-263-1290
Provider Business Mailing Address Fax Number:
608-263-9424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2880 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
ROOM 177
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53705-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-263-9393
Provider Business Practice Location Address Fax Number:
608-263-7945
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAPLAN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
608-263-7013

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  6986 , 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)

  • Identifier: 33211800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6986 . This is a "PHARMACY LICENSE NO" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0641600005 . This is a "PTAN (PHARMACY MEDICARE PROVIDER NUMBER)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5121455 . This is a "NCPDP NO" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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