Provider Demographics
NPI:1235322850
Name:UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC
Entity Type:Organization
Organization Name:UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION INC
Other - Org Name:UW HEALTH OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO & CFO UW HEALTH-UW MEDICAL FOUN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANNERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-821-4223
Mailing Address - Street 1:7974 UW HEALTH COURT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:608-829-5270
Mailing Address - Fax:608-833-0999
Practice Address - Street 1:2349 DEMING WAY
Practice Address - Street 2:2ND FLR
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5530
Practice Address - Country:US
Practice Address - Phone:608-824-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38722900Medicaid
WI38722900Medicaid