Provider Demographics
NPI:1245310721
Name:UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY
Entity type:Organization
Organization Name:UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY
Other - Org Name:<UNAVAIL>
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:COMPLIANCE MAIL CODE 2433
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-0001
Mailing Address - Country:US
Mailing Address - Phone:608-662-0817
Mailing Address - Fax:
Practice Address - Street 1:2402 WINNEBAGO ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5341
Practice Address - Country:US
Practice Address - Phone:608-242-6862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9435-42333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33284300Medicaid
WI9435-42OtherPHARMACY LICENSE
WI5121568OtherNCPDP NO
WIFU6463119OtherDEA
WI0641600008Medicare NSC