1437604691 NPI number — EDGEWOOD COLLEGE HEALTH SERVICES

Table of content: SKYLAR DANAE WALK OTD (NPI 1710866173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437604691 NPI number — EDGEWOOD COLLEGE HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDGEWOOD COLLEGE HEALTH SERVICES
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:
1437604691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 EDGEWOOD COLLEGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53711-1997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-663-8334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 EDGEWOOD COLLEGE DR
Provider Second Line Business Practice Location Address:
PREDOLIN 208
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-772-3004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MORELAND
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR, HEALTH SERVICES
Authorized Official Telephone Number:
608-663-8334

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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