Provider Demographics
NPI:1003840604
Name:VILLAGE OF BIG BEND
Entity Type:Organization
Organization Name:VILLAGE OF BIG BEND
Other - Org Name:BIG BEND FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SONEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-662-2747
Mailing Address - Street 1:W230S9185 NEVINS ST
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9722
Mailing Address - Country:US
Mailing Address - Phone:262-662-2747
Mailing Address - Fax:262-662-3751
Practice Address - Street 1:W230S9185 NEVINS ST
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9722
Practice Address - Country:US
Practice Address - Phone:262-662-2747
Practice Address - Fax:262-662-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI673603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41358000Medicaid
WI000085036Medicare ID - Type UnspecifiedAMBULANCE