1861610883 NPI number — STRATFORD AREA FIRE DEPARTMENT

Table of content: (NPI 1861610883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861610883 NPI number — STRATFORD AREA FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATFORD AREA FIRE DEPARTMENT
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:
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:
1861610883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54484-0103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-387-3988
Provider Business Mailing Address Fax Number:
715-387-0646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212200 STATE HIGHWAY 97
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54484-4326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-687-4157
Provider Business Practice Location Address Fax Number:
715-391-1040
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WIESMAN
Authorized Official First Name:
TROY
Authorized Official Middle Name:
Authorized Official Title or Position:
COMMISSION CHAIRPERSON
Authorized Official Telephone Number:
715-897-4589

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  60-355 , 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: 231652151A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41343500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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