Provider Demographics
NPI:1649350075
Name:UNIVERSITY OF WISCONSIN HOSPITALS & CLINICS AUTHORITY
Entity type:Organization
Organization Name:UNIVERSITY OF WISCONSIN HOSPITALS & CLINICS AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-263-7897
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 1:20 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1348
Practice Address - Country:US
Practice Address - Phone:608-287-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF WISCONSIN HOSPITALS & 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
WI8513333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5120631OtherNCPDP NO
WI33284500Medicaid
WI8513OtherPHARMACY LICENSE NO
WIBU9484736OtherDEA NO
WI5120631OtherNCPDP NO