1801882691 NPI number — CITY OF MONONA

Table of content: (NPI 1801882691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801882691 NPI number — CITY OF MONONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MONONA
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:
1801882691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5211 SCHLUTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONONA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53716-2533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-222-2525
Provider Business Mailing Address Fax Number:
608-222-9225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5211 SCHLUTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53716-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-222-2525
Provider Business Practice Location Address Fax Number:
608-222-9225
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCMULLEN
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE AND EMS CHIEF
Authorized Official Telephone Number:
608-216-7442

Provider Taxonomy Codes

  • Taxonomy code: 146M00000X , with the licence number:  6001194 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41313800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590002965 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 247688 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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