Provider Demographics
NPI:1124155403
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:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-263-5993
Mailing Address - Street 1:1500 HIGHLAND AVE
Mailing Address - Street 2:WAISMAN CENTER RM 362
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2280
Mailing Address - Country:US
Mailing Address - Phone:608-263-5993
Mailing Address - Fax:608-263-0530
Practice Address - Street 1:1500 HIGHLAND AVE
Practice Address - Street 2:WAISMAN CENTER RM 362
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2280
Practice Address - Country:US
Practice Address - Phone:608-263-5993
Practice Address - Fax:608-263-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52D0662277CLIA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32907000Medicaid
WI000089834OtherMEDICARE
WI000089834Medicare ID - Type Unspecified