1427005073 NPI number — VILLAGE OF RAYMOND

Table of content: DR. ERIC SCOTT ZICKERMAN D.O. (NPI 1578751319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427005073 NPI number — VILLAGE OF RAYMOND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF RAYMOND
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:
RAYMOND FIRE AND RESCUE
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:
1427005073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2255 76TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKSVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53126-9539
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:
2255 76TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKSVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53126-9539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-835-1687
Provider Business Practice Location Address Fax Number:
262-835-1694
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
262-835-1687

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: 41316700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590007538 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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