STATE OF WISCONSIN (NPI# 1437253648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437253648 |
| Entity Type | Organization |
| Organization Name | STATE OF WISCONSIN |
| Other Organization Name | MENDOTA MENTAL HEALTH INSTITUTE |
| Practice Address |
301 Troy Dr Madison WI 53704-1521 |
| Practice Telephone | 6083011000 |
| Practice Fax Number | 6083011390 |
| Mailing Telephone | 6083011000 |
| Mailing Fax Number | 6083011390 |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2008-06-26 |
| Authorized Official Name | DR. GREG J VAN RYBROECK (DIRECTOR) |
| Authorized Official Telephone | 6083011042 |
| Authorized Official Credential | PHD JD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | 283Q00000X | WI | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 10063400 | 05 |
| Other Name | Type Code |
|---|---|
| Mendota Mental Health Institute | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558615815 | State of Wisconsin | Skilled Nursing Facility | 2175 E Park Ave, Chippewa Falls, WI 54729-3511 | 2012-11-07 |
| 1225152861 | State of Wisconsin | Skilled Nursing Facility | 21425g Spring St, Union Grove, WI 53182-9707 | 2007-03-19 |
| 1235225616 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 2820 East Park Avenue, Chippewa Falls, WI 54729-0340 | 2006-10-05 |
| 1366439986 | State of Wisconsin | Skilled Nursing Facility | N2665 County Road Qq, King, WI 54946 | 2005-09-29 |
| 1225362403 | State of Wisconsin | Durable Medical Equipment & Medical Supplies | 317 Knutson Dr, Madison, WI 53704-1133 | 2009-09-22 |
| 1336324946 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 317 Knutson Dr, Madison, WI 53704-1133 | 2008-01-02 |
| 1588703078 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2007-02-05 |
| 1386705655 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2006-12-12 |
| 1164516506 | State of Wisconsin | Psychiatric Hospital | 1300 South Drive, Winnebago, WI 54985-0009 | 2006-10-02 |
| 1043326747 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 21425 Spring St, Union Grove, WI 53182-9707 | 2006-08-22 |
| Street Address |
301 TROY DR |
| City | MADISON |
| State | WI |
| Zip Code | 53704-1521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629044797 | Michael T Witkovsky | Psychiatry & Neurology | 301 Troy Dr, Madison, WI 53704-1521 | 2006-02-27 |
| 1790311017 | Joshua Seth Camins | Psychologist | 301 Troy Dr, Madison, WI 53704-1521 | 2020-03-18 |
| 1316583909 | Thomas A Deboer | Psychologist | 301 Troy Dr, Madison, WI 53704-1521 | 2019-11-19 |
| 1811531155 | Kristin A Johnson | Psychologist | 301 Troy Dr, Madison, WI 53704-1521 | 2019-10-30 |
| 1861912958 | Emily Peissig | Counselor | 301 Troy Dr, Madison, WI 53704-1521 | 2017-06-21 |
| 1275083958 | Caroline Carr | Psychologist | 301 Troy Dr, Madison, WI 53704-1521 | 2016-10-06 |
| 1427429653 | Samantha Marsh | Pharmacist | 301 Troy Dr, Madison, WI 53704-1521 | 2015-10-14 |
| 1770840118 | Adrea Hahn Mcglynn | Psychologist | 301 Troy Dr, Madison, WI 53704-1521 | 2012-04-23 |
| 1861636672 | St. Charles Youth & Family Services | Clinic/Center | 301 Troy Dr, Cottage A, Madison, WI 53704-1521 | 2009-04-23 |
| 1063653954 | Michael J Vitacco | Psychologist | 301 Troy Dr, Madison, WI 53704-1521 | 2009-03-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407369614 | Joseph Michael Oakley II | Chiropractor | 2801 International Ln Ste 102, Madison, WI 53704 | 2017-11-09 |
| 1972015048 | Suzanne Lee | Psychiatry & Neurology | 1835 Winnebago St. #402, Madison, WI 53704 | 2017-10-30 |
| 1831554021 | Gideon Kazah | Licensed Practical Nurse | 2488 Dahle Street, Madison, WI 53704 | 2015-12-15 |
| 1174952220 | Group Health Cooperative of South Central Wisconsin Madison College | Durable Medical Equipment & Medical Supplies | 1705 Hoffman Street, Madison, WI 53704 | 2013-11-08 |
| 1407190127 | Ashley Marie Snyder | Social Worker | 5203 Autumn Leaf Lane, Apt. 389, Madison, WI 53704 | 2012-11-19 |
| 1619230638 | Dawn Lynette Butts | Optometrist | 4208 E Washington Ave, Madison, WI 53704 | 2012-06-25 |
| 1679865992 | Sharon Kelley | Psychologist | 1213 N. Sherman Ave, Suite 334, Madison, WI 53704 | 2011-05-04 |
| 1578730412 | St. Charles Youth & Family Services | Community Based Residential Treatment Facility, Mental Illness | 310 Troy Dr, Cottage B, Madison, WI 53704 | 2008-05-09 |
| 1538346960 | Elizabeth Ann Reiser-loeber | Dentist | 1001 N. Sherman Ave, Madison, WI 53704 | 2008-01-28 |
| 1861683088 | Stephen Dale Flach | Internal Medicine | Covance, 3402 Kinsman Blvd, Madison, WI 53704 | 2007-08-05 |
| Find all providers in zip 53704 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003349028 | Ditte Primdahl | General Acute Care Hospital | 1685 Highland, Madison, WI 53705-2281 | 2017-04-06 |
| 1336522259 | Zachary Cuellar | General Acute Care Hospital | 702 Lorillard Ct # E303, Madison, WI 53703-3897 | 2015-07-09 |
| 1528371119 | University Physicians. Pllc | General Acute Care Hospital | 121 Beaufort Cir, Madison, MS 39110-7962 | 2010-07-23 |
| 1184621211 | Ssm Health Care of Wisconsin, Inc. | General Acute Care Hospital | 700 S. Park St., Madison, WI 53715-1830 | 2005-07-05 |
| 1710430764 | Madison Hospital | General Acute Care Hospital | 8375 Highway 72 W, Madison, AL 35758-9573 | 2016-07-26 |
| 1902290034 | Ssm Health Care of Wisconsin Inc | General Acute Care Hospital | 700 S Park St, Madison, WI 53715-1830 | 2015-03-26 |
| 1427309269 | William S. Middleton Memorial Va Hospital | General Acute Care Hospital | 2500 Overlook Ter, Madison, WI 53705-2254 | 2012-09-19 |
| 1164651949 | Southwest | General Acute Care Hospital | 1 W Wilson St, Madison, WI 53703-3445 | 2009-07-14 |
| 1124282652 | University of Wisconsin Hospital and Clinics | General Acute Care Hospital | 600 Highland Ave, Madison, WI 53792-0001 | 2008-07-14 |
| 1023232592 | The Kings Daughters Hospital and Health Services | General Acute Care Hospital | 1 Kings Daughters Dr, Madison, IN 47250-3300 | 2007-04-13 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.