1063744639 NPI number — TOWN OF CONOVER

Table of content: (NPI 1063744639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063744639 NPI number — TOWN OF CONOVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF CONOVER
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:
TOWN OF CONOVER AMBULANCE SERVICE
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:
1063744639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 627
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56307-0627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-209-8125
Provider Business Mailing Address Fax Number:
877-715-7608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4665 COUNTY K E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONOVER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54519-0115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-479-8688
Provider Business Practice Location Address Fax Number:
715-479-8688
Provider Enumeration Date:
02/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MERGEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
GM
Authorized Official Telephone Number:
320-209-8125

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6011195 , 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)





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