1720071723 NPI number — TOWN OF LAC DU FLAMBEAU

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720071723 NPI number — TOWN OF LAC DU FLAMBEAU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF LAC DU FLAMBEAU
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:
LAC DU FLAMBEAU AMBULANCE SERVICE
Provider Other Organization Name Type Code:
5
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:
1720071723
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 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAC DU FLAMBEAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54538-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-588-3358
Provider Business Mailing Address Fax Number:
715-588-7923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
614 WILD RICE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAC DU FLAMBEAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-588-3358
Provider Business Practice Location Address Fax Number:
715-588-7923
Provider Enumeration Date:
08/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BICKELHAUPT
Authorized Official First Name:
JANET
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
DEPUTY TOWN CLERK
Authorized Official Telephone Number:
715-588-3358

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  6000703 , 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: 41331000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".