1679784029 NPI number — VILLAGE OF CAMBRIA

Table of content: (NPI 1679784029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679784029 NPI number — VILLAGE OF CAMBRIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF CAMBRIA
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:
CAMBRIA COMMUNITY AMBULANCE
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:
1679784029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 295
Provider Second Line Business Mailing Address:
111 W EDGEWATER STREET
Provider Business Mailing Address City Name:
CAMBRIA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53923-0295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-348-5443
Provider Business Mailing Address Fax Number:
920-348-6050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 ELIZABETH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-348-5501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRATKY
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
920-348-5443

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  6001091 , 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: 41325700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com