1821043910 NPI number — DELLS-DELTON EMS COMMISSION

Table of content: (NPI 1821043910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821043910 NPI number — DELLS-DELTON EMS COMMISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELLS-DELTON EMS COMMISSION
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:
1821043910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE DELTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53940-0148
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:
30 WISCONSIN DELLS PARKWAY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE DELTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-254-2159
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
JANENE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
608-254-2159

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: 41359800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: WI0100 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95766 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1042692 . This is a "PHYSICIAN'S PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 128443600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8181670 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0572800 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 084320 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000081495 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4570350 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 487393700 . This is a "WORKER'S COMPENSATION" identifier . This identifiers is of the category "OTHER".




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