Provider Demographics
NPI:1295905081
Name:UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Entity type:Organization
Organization Name:UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-472-1300
Mailing Address - Street 1:710 W. STARIN RD.
Mailing Address - Street 2:AMBROSE HEALTH CENTER
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1338
Mailing Address - Country:US
Mailing Address - Phone:262-472-1300
Mailing Address - Fax:262-472-1435
Practice Address - Street 1:710 W. STARIN RD.
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1338
Practice Address - Country:US
Practice Address - Phone:262-472-1300
Practice Address - Fax:262-472-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42012800Medicaid