1912997248 NPI number — CITY OF MADISON

Table of content: (NPI 1912997248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912997248 NPI number — CITY OF MADISON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MADISON
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:
1912997248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
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:
RM 406
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:
608-266-4677
Provider Business Mailing Address Fax Number:
608-261-4238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 W JOHNSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53703-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-266-4021
Provider Business Practice Location Address Fax Number:
608-267-1153
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIEDICKE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
608-267-8710

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6000358 , 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: 41313100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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