Provider Demographics
NPI:1093752362
Name:TOWN OF LINN
Entity Type:Organization
Organization Name:TOWN OF LINN
Other - Org Name:TOWN OF LINN FIRE & EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLYACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-275-6300
Mailing Address - Street 1:N1457 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4235
Mailing Address - Country:US
Mailing Address - Phone:262-275-6300
Mailing Address - Fax:262-275-8261
Practice Address - Street 1:N1457 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4235
Practice Address - Country:US
Practice Address - Phone:262-275-6300
Practice Address - Fax:262-275-8261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF LINN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-02
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012573416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41356100OtherH.I.R.S.P.
WIP00231925OtherRAILROAD MEDICARE
WI41356100Medicaid
WI41356100OtherWISCONSIN RENAL PROGRAM
WIP00231925OtherRAILROAD MEDICARE
IL=========001Medicaid