Provider Demographics
NPI:1669458386
Name:UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Entity Type:Organization
Organization Name:UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Other - Org Name:BOARD OF REGENTS UNIVERSITY OF WIS SYSTEM WI STATE LABORATORY OF HYGIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF CLINICAL TEST
Authorized Official - Prefix:
Authorized Official - First Name:ERRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-890-0288
Mailing Address - Street 1:465 HENRY MALL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53706-1378
Mailing Address - Country:US
Mailing Address - Phone:608-262-3911
Mailing Address - Fax:608-262-3257
Practice Address - Street 1:465 HENRY MALL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53706-1378
Practice Address - Country:US
Practice Address - Phone:608-262-3911
Practice Address - Fax:608-262-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D0669558291U00000X
WI52D0661989291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32908700Medicaid
WI32908700Medicaid