Provider Demographics
NPI:1639594401
Name:UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY
Entity Type:Organization
Organization Name:UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-263-7013
Mailing Address - Street 1:600 HIGHLAND AVE
Mailing Address - Street 2:PHARMACY F6/133
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-0001
Mailing Address - Country:US
Mailing Address - Phone:608-263-1290
Mailing Address - Fax:608-263-9424
Practice Address - Street 1:3434 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4155
Practice Address - Country:US
Practice Address - Phone:608-890-6431
Practice Address - Fax:608-203-4894
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UW HEALTH REMOTE DISPENSING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-03
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9239-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIFU7269574Medicaid