MEDICARE: UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649230475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	7974 UW HEALTH COURT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:	608-829-5270
Fax Number	:	608-833-5039

Provider Business Practice Location Address
First Line	:	207 W LINCOLN ST
Second Line	:	SUITE 1
City	:	AUGUSTA
State	:	WI
Zip	:	54722-9156
Country	:	US
Telephone Number	:	715-286-2270
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	JEFFREY GROSSMAN
Credential	:
Telephone Number	:	608-263-7013

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/22/2014

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