Provider Demographics
NPI:1104140706
Name:PUBLIC HEALTH MADISON AND DANE COUNTY
Entity type:Organization
Organization Name:PUBLIC HEALTH MADISON AND DANE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHLENKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-243-0300
Mailing Address - Street 1:210 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:ROOM 507
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3340
Mailing Address - Country:US
Mailing Address - Phone:608-266-4821
Mailing Address - Fax:608-266-4858
Practice Address - Street 1:210 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:ROOM 507
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3340
Practice Address - Country:US
Practice Address - Phone:608-266-4821
Practice Address - Fax:608-266-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487763124Medicare UPIN