1225142698 NPI number — VILLAGE OF ELM GROVE

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 1225142698 NPI number — VILLAGE OF ELM GROVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF ELM GROVE
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:
1225142698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDARBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53012-7340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-375-9610
Provider Business Mailing Address Fax Number:
262-375-9608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13600 JUNEAU BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELM GROVE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53122-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-782-6700
Provider Business Practice Location Address Fax Number:
262-782-8714
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHERFF SULIK
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
262-375-9610

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: 41349100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com