Provider Demographics
NPI:1225041940
Name:TOWN OF CLOVER
Entity Type:Organization
Organization Name:TOWN OF CLOVER
Other - Org Name:SOUTH SHORE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TOWN CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENWINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-774-3780
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:HERBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54844-0094
Mailing Address - Country:US
Mailing Address - Phone:715-774-3780
Mailing Address - Fax:
Practice Address - Street 1:86980 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:HERBSTER
Practice Address - State:WI
Practice Address - Zip Code:54844
Practice Address - Country:US
Practice Address - Phone:715-774-3781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000081449Medicare ID - Type UnspecifiedPROVIDER NUMBER