Basic Information
| Provider Information | |||||||||
| NPI: | 1801229547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN EAST CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1265 JOHN Q HAMMONS DRIVE | ||||||||
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| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537174971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082514156 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5249 E TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082229777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2013 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | BENJAMIN | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6082514156 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.