1760461743 NPI number — VILLAGE OF COLFAX

Table of content: (NPI 1760461743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760461743 NPI number — VILLAGE OF COLFAX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF COLFAX
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:
COLFAX RESCUE SQUAD
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:
1760461743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 417
Provider Second Line Business Mailing Address:
614C RAILROAD AVE
Provider Business Mailing Address City Name:
COLFAX
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54730-9148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-962-3049
Provider Business Mailing Address Fax Number:
715-962-2032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
614C RAILROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLFAX
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54730-9148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-962-3049
Provider Business Practice Location Address Fax Number:
715-962-2032
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNUTSON
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
ROGER
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-962-3049

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  6000760 , 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: 590656458 . This is a "RR MEDICARE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 396006469 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000084671 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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