1205881760 NPI number — CADDOT COMMUNITY AMBULANCE VILL OF CADDOT-ARTHUR-GOETZ-SIGEL

Table of content: (NPI 1205881760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205881760 NPI number — CADDOT COMMUNITY AMBULANCE VILL OF CADDOT-ARTHUR-GOETZ-SIGEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CADDOT COMMUNITY AMBULANCE VILL OF CADDOT-ARTHUR-GOETZ-SIGEL
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:
Provider Other Organization Name Type Code:
6
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:
1205881760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CADOTT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54727-0007
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:
436 E HARTFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CADOTT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-289-3621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTERS
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
715-289-3621

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: 41340800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000088107 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012394 . This is a "PHYSICIAN'S PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8182554 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38229 . This is a "NETWORK HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000088107 . This is a "TMG" identifier . This identifiers is of the category "OTHER".
  • Identifier: WI0101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".




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