Provider Demographics
NPI:1225142698
Name:VILLAGE OF ELM GROVE
Entity Type:Organization
Organization Name:VILLAGE OF ELM GROVE
Other - Org Name:ELM GROVE EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHERFF SULIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-375-9610
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 1:13600 JUNEAU BLVD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-1654
Practice Address - Country:US
Practice Address - Phone:262-782-6700
Practice Address - Fax:262-782-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41349100Medicaid
WI000083359Medicare PIN