Provider Demographics
NPI:1154323129
Name:CITY OF WHITEWATER
Entity Type:Organization
Organization Name:CITY OF WHITEWATER
Other - Org Name:WHITEWATER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-473-1382
Mailing Address - Street 1:PO BOX 72140
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-7340
Mailing Address - Country:US
Mailing Address - Phone:262-375-9610
Mailing Address - Fax:262-375-9608
Practice Address - Street 1:312 W WHITEWATER ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1940
Practice Address - Country:US
Practice Address - Phone:262-473-0510
Practice Address - Fax:262-375-9608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60005123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI504844OtherDEAN CARE
WI41342300Medicaid
WI590012061OtherRR MEDICARE
WI504844OtherDEAN CARE