1194998716 NPI number — WISCONSIN CENTER FOR THE BLIND AND VISUALLY IMPAIRED

Table of content: (NPI 1194998716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194998716 NPI number — WISCONSIN CENTER FOR THE BLIND AND VISUALLY IMPAIRED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISCONSIN CENTER FOR THE BLIND AND VISUALLY IMPAIRED
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:
1194998716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 W STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JANESVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53546-5344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-758-6100
Provider Business Mailing Address Fax Number:
608-758-6158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 W STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JANESVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53546-5344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-758-6100
Provider Business Practice Location Address Fax Number:
608-758-6158
Provider Enumeration Date:
04/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MULLIGAN
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
NURSING SUPERVISOR
Authorized Official Telephone Number:
608-758-6100

Provider Taxonomy Codes

  • Taxonomy code: 163WS0200X , 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: 44218100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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