=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295905081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2008
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 W. STARIN RD.
-----------------------------------------------------
City | WHITEWATER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53190-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-472-1300
-----------------------------------------------------
Fax | 262-472-1435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 W. STARIN RD. AMBROSE HEALTH CENTER
-----------------------------------------------------
City | WHITEWATER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53190-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-472-1300
-----------------------------------------------------
Fax | 262-472-1435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL SUPERVISOR
-----------------------------------------------------
Name | DR. DONENE ROWE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 262-472-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------