Provider Demographics
NPI:1053317859
Name:VILLAGE OF ALLOUEZ
Entity Type:Organization
Organization Name:VILLAGE OF ALLOUEZ
Other - Org Name:VILLAGE OF ALLOUEZ - FIRE DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOXWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-448-2800
Mailing Address - Street 1:1900 LIBAL ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2453
Mailing Address - Country:US
Mailing Address - Phone:920-448-2800
Mailing Address - Fax:920-448-2850
Practice Address - Street 1:135 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2109
Practice Address - Country:US
Practice Address - Phone:920-448-2806
Practice Address - Fax:920-448-2851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60010053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41314400Medicaid