1053317859 NPI number — VILLAGE OF ALLOUEZ

Table of content: (NPI 1053317859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053317859 NPI number — VILLAGE OF ALLOUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF ALLOUEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VILLAGE OF ALLOUEZ - FIRE DEPT.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053317859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 LIBAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54301-2453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-448-2800
Provider Business Mailing Address Fax Number:
920-448-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 DAUPHIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-448-2806
Provider Business Practice Location Address Fax Number:
920-448-2851
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FOXWORTHY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
920-448-2800

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6001005 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41314400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com