Provider Demographics
NPI:1114075389
Name:CITY OF GREEN BAY OFFICE OF COMPTROLLER
Entity Type:Organization
Organization Name:CITY OF GREEN BAY OFFICE OF COMPTROLLER
Other - Org Name:CITY OF GREEN BAY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-448-3278
Mailing Address - Street 1:501 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4218
Mailing Address - Country:US
Mailing Address - Phone:920-448-3277
Mailing Address - Fax:920-448-3281
Practice Address - Street 1:501 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4218
Practice Address - Country:US
Practice Address - Phone:920-448-3277
Practice Address - Fax:920-448-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60001683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41348600Medicaid
WI590094290OtherMEDICARE RAILROAD
WI41348600Medicaid
WI000081904Medicare ID - Type Unspecified