1922051960 NPI number — CHIPPEWA FIRE PROTECTION DISTRICT INC.

Table of content: (NPI 1922051960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922051960 NPI number — CHIPPEWA FIRE PROTECTION DISTRICT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIPPEWA FIRE PROTECTION DISTRICT INC.
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:
1922051960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13143 30TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHIPPEWA FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54729-7377
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:
13143 30TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-7377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-723-5488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERNETTE
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
715-723-5488

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: 41345600 . This is a "HIRSP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 8182696 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: WI0101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41345600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41345600 . This is a "WI RENAL PROGRAM" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 000085983 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 790268900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282309400 . This is a "WORKER'S COMPENSATION" identifier . This identifiers is of the category "OTHER".




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