State Medicaid
State Medicaid is a Preferred Provider Organization in Sun Prairie, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2006.
- Licensed in
- WI
- In the registry since
- 2006
Practice location Address checks out
824 Lothe StSun Prairie, WI 53590-2710
Phone: (608) 334-0900
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Preferred Provider Organization (primary) | Taxonomy 305R00000X (WI) |
|---|
Record details
| NPI number | 1891898219 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Janice Remus — Case Manager · (608) 848-7745 |
| NPI enumerated | September 7, 2006 |
| Last updated in NPPES | August 22, 2020 |
| Mailing address | 824 Lothe St, Sun Prairie, WI 53590-2710 |