MEDICARE: UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1871742445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL

Provider Business Mailing Address
First Line	:	712 BROADWAY ST S
Second Line	:
City	:	MENOMONIE
State	:	WI
Zip	:	54751-2458
Country	:	US
Telephone Number	:	715-232-2329
Fax Number	:	715-232-2307

Provider Business Practice Location Address
First Line	:	221 10TH AVENUE EAST
Second Line	:	VOCATIONAL REHABILITATION BUILDING
City	:	MENOMONIE
State	:	WI
Zip	:	54751-2474
Country	:	US
Telephone Number	:	715-232-1419
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF ACCOUNTING SERVICES
Name	:	MR. THEODORE G WENUM
Credential	:
Telephone Number	:	715-232-2329

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	12/04/2024

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