1104871441 NPI number — TOWN OF PRESQUE ISLE

Table of content: (NPI 1104871441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104871441 NPI number — TOWN OF PRESQUE ISLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF PRESQUE ISLE
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:
PRESQUE ISLE VOLUNTEER FIRE DEPARTMENT
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:
1104871441
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:
PO BOX 221
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESQUE ISLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54557-0221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SCHOOL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESQUE ISLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-356-2262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JUKICH
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
COORDINATOR
Authorized Official Telephone Number:
715-356-2262

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41328300 . This is a "HIRSP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 31126 . This is a "NETWORK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: WI0101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41328300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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