Provider Demographics
NPI:1073564241
Name:CITY OF WEST ALLIS
Entity Type:Organization
Organization Name:CITY OF WEST ALLIS
Other - Org Name:CITY OF WEST ALLIS FIRE DEPT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-302-8904
Mailing Address - Street 1:7332 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4736
Mailing Address - Country:US
Mailing Address - Phone:414-302-8910
Mailing Address - Fax:
Practice Address - Street 1:7332 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4736
Practice Address - Country:US
Practice Address - Phone:414-302-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
41352100OtherNETWORK HEALTH PLAN MAHMO
41352100OtherMANAGED HEALTH MAHMO
1012463OtherPHYSICIAN'S PLUS
WI41352100Medicaid
037381OtherHEALTH ALLIANCE MEDICAL
WI41352100OtherGAMP
5553OtherNETWORK HEALTH PLAN CONVE
MN6283128-00Medicaid
0000003962OtherVITAS HEALTHCARE CORP
WI0101OtherJOHN DEERE
000083917OtherADVOCARE MC HMO
IA0980516OtherMEDICAL ASSOCIATES HMO
AZ942377Medicaid
WI41352100OtherHIRSP
=========015OtherVALLEY HEALTH PLAN
WI0101OtherJOHN DEERE