Provider Demographics
NPI:1235186883
Name:CITY OF BEAVER DAM ET AL
Entity Type:Organization
Organization Name:CITY OF BEAVER DAM ET AL
Other - Org Name:BEAVER DAM FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-887-4600
Mailing Address - Street 1:205 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2323
Practice Address - Country:US
Practice Address - Phone:920-887-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41319900Medicaid
WI590094661OtherRAILROAD MEDICARE
WI590094661OtherRAILROAD MEDICARE