1558531251 NPI number — UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL

Table of content: (NPI 1558531251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558531251 NPI number — UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
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:
1558531251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 1ST AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENOMONIE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54751-1876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-232-1314
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 1ST AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENOMONIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54751-1876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-232-1314
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAMAEKER
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
DIRECTOR/ADMINISTRATOR
Authorized Official Telephone Number:
715-232-2114

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X , with the licence number:  34254-020 , 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: 32118900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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