Provider Demographics
NPI:1164601522
Name:VILLAGE OF PLUM CITY
Entity Type:Organization
Organization Name:VILLAGE OF PLUM CITY
Other - Org Name:MAIDEN ROCK - PLUM CITY - STOCKHOLM AREA AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-647-2141
Mailing Address - Street 1:223 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PLUM CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54761-9002
Mailing Address - Country:US
Mailing Address - Phone:715-647-2141
Mailing Address - Fax:
Practice Address - Street 1:309 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:PLUM CITY
Practice Address - State:WI
Practice Address - Zip Code:54761-9015
Practice Address - Country:US
Practice Address - Phone:715-647-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001242341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance