Provider Demographics
NPI:1659423986
Name:UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
Other - Org Name:UW HEALTH EYE CLINIC-ROCKFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PATIENT BUSINESS SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-829-5625
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:608-833-6965
Practice Address - Street 1:7019 ROTE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-2611
Practice Address - Country:US
Practice Address - Phone:815-399-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1111570037Medicare NSC