Provider Demographics
NPI:1013597400
Name:TOWN OF MARENGO
Entity Type:Organization
Organization Name:TOWN OF MARENGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:715-413-1374
Mailing Address - Street 1:40345 HANNINEN RD
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:WI
Mailing Address - Zip Code:54855-4512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41652 FIRE DEPARTMENT AVE
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:WI
Practice Address - Zip Code:54855-3491
Practice Address - Country:US
Practice Address - Phone:715-413-1374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF MARENGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance