Provider Demographics
NPI:1134105505
Name:UNIVERSITY OF WISCONSIN OSHKOSH STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF WISCONSIN OSHKOSH STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZANTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-424-2424
Mailing Address - Street 1:777 ALGOMA BLVD
Mailing Address - Street 2:RADFORD HALL
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-3534
Mailing Address - Country:US
Mailing Address - Phone:920-424-2424
Mailing Address - Fax:920-424-1769
Practice Address - Street 1:777 ALGOMA BLVD
Practice Address - Street 2:RADFORD HALL
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3534
Practice Address - Country:US
Practice Address - Phone:920-424-2424
Practice Address - Fax:920-424-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41873200Medicaid