Provider Demographics
NPI:1780772236
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 1:702 N MIDVALE BLVD
Practice Address - Street 2:SUITE 168
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3261
Practice Address - Country:US
Practice Address - Phone:608-263-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF WISCONSIN HOSPITALS & CLINICS AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8221333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8221OtherPHARMACY LICENSE NO
WI5126809OtherNCPDP NO
WI33262600Medicaid
WI33262600Medicaid
WI8221OtherPHARMACY LICENSE NO