Provider Demographics
NPI:1073889580
Name:VILLAGE OF PALMYRA
Entity Type:Organization
Organization Name:VILLAGE OF PALMYRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:KREGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-495-2380
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:100 W TAFT ST.
Mailing Address - City:PALMYRA
Mailing Address - State:WI
Mailing Address - Zip Code:53156
Mailing Address - Country:US
Mailing Address - Phone:262-495-8316
Mailing Address - Fax:262-495-8775
Practice Address - Street 1:126 N. FIRST STREET
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156
Practice Address - Country:US
Practice Address - Phone:262-495-2380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66049213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport