1124155403 NPI number — UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL

Table of content: (NPI 1124155403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124155403 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:
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:
1124155403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 HIGHLAND AVE
Provider Second Line Business Mailing Address:
WAISMAN CENTER RM 362
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53705-2280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-263-5993
Provider Business Mailing Address Fax Number:
608-263-0530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
WAISMAN CENTER RM 362
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53705-2280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-263-5993
Provider Business Practice Location Address Fax Number:
608-263-0530
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFF
Authorized Official First Name:
JON
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
608-263-5993

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  52D0662277CLIA , 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: 32907000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000089834 . This is a "MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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