Provider Demographics
NPI:1316005978
Name:CITY OF JANESVILLE
Entity Type:Organization
Organization Name:CITY OF JANESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:STOTTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-755-3072
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:800-329-5274
Practice Address - Street 1:18 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548
Practice Address - Country:US
Practice Address - Phone:608-755-3000
Practice Address - Fax:608-755-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41322800Medicaid