State Medicaid
NPI #1891898219 in Sun Prairie, Wisconsin
Provider Information
- NPI Number
- 1891898219
- Entity Type
- Organization
- Organization Name
- State Medicaid
- Primary Specialty
- Preferred Provider Organization
- Enumeration Date
- Sep 7, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 824 LOTHE ST
- City
- Sun Prairie
- State
- Wisconsin
- ZIP Code
- 53590-2710
- Phone
- (608) 334-0900
Authorized Official
- Name
- MISS JANICE REMUS, RN
- Title
- CASE MANAGER
- Phone
- (608) 848-7745
Specialties & Taxonomy Codes
| Specialty |
|---|
| Preferred Provider Organization |
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