1831248475 NPI number — TOWN OF IRON RIVER

Table of content: (NPI 1831248475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831248475 NPI number — TOWN OF IRON RIVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF IRON RIVER
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:
1831248475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8285 US HIGHWAY 2
Provider Second Line Business Mailing Address:
P.O. BOX 53
Provider Business Mailing Address City Name:
IRON RIVER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54847-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-372-8774
Provider Business Mailing Address Fax Number:
715-372-4394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8285 US HIGHWAY 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRON RIVER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54847-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-372-8774
Provider Business Practice Location Address Fax Number:
715-372-4394
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MULLOZZI
Authorized Official First Name:
MARY(MICKY)
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
EMERGENCY MEDICAL TECHNITIAN-BILLIN
Authorized Official Telephone Number:
715-372-8774

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6000776 , 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: 6000776 . This is a "STATE LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41333000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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