Provider Demographics
NPI:1073739165
Name:CITY OF MELLEN
Entity Type:Organization
Organization Name:CITY OF MELLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CLERK-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCRIBNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-274-2136
Mailing Address - Street 1:102 EAST BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:MELLEN
Mailing Address - State:WI
Mailing Address - Zip Code:54546
Mailing Address - Country:US
Mailing Address - Phone:715-274-2136
Mailing Address - Fax:715-274-3707
Practice Address - Street 1:102 EAST BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MELLEN
Practice Address - State:WI
Practice Address - Zip Code:54546
Practice Address - Country:US
Practice Address - Phone:715-274-2136
Practice Address - Fax:715-274-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000118146N00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41333800Medicaid
WI41333800Medicaid
WI1073739165Medicare UPIN