Basic Information
Provider Information | |||||||||
NPI: | 1598295610 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | UW HEALTH REMOTE DISPENSING SERVICES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 600 HIGHLAND AVE | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | WI | ||||||||
PostalCode: | 537920001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6086620817 | ||||||||
FaxNumber: | 6082034544 | ||||||||
Practice Location | |||||||||
Address1: | 6041 BASSWOOD DRIVE | ||||||||
Address2: |   | ||||||||
City: | FITCHBURG | ||||||||
State: | WI | ||||||||
PostalCode: | 537195102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6085044500 | ||||||||
FaxNumber: | 6085044510 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2017 | ||||||||
LastUpdateDate: | 06/13/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KAPLAN | ||||||||
AuthorizedOfficialFirstName: | ALAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 6082637013 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X |   |   | Y |   | Suppliers | Pharmacy |   |
No ID Information.