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General NPI Number Information
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NPI Number | 1063682938
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1300 BADGER ST SUITE 1030
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City | LA CROSSE
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State | WI
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Zip | 54601-1502
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Country | US
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Telephone | 608-785-8558
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Fax | 608-785-8746
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Provider Business Mailing Address
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Address Line | 1300 BADGER ST SUITE 1030
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City | LA CROSSE
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State | WI
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Zip | 54601-1502
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Country | US
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Telephone | 608-785-8558
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Fax | 608-785-8746
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Authorized Official
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Title or Position | DIRECTOR/PHYSICIAN
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Name | DR. BRIAN K. ALLEN
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Credential | D.O.
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Telephone | 608-785-8558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 28854
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License Number State | WI
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