Provider Demographics
NPI:1346340163
Name:VILLAGE OF CALEDONIA
Entity Type:Organization
Organization Name:VILLAGE OF CALEDONIA
Other - Org Name:CALEDONIA MT. PLEASANT HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:AO
Authorized Official - Last Name:GESNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-835-6429
Mailing Address - Street 1:6922 NICHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53108-9648
Mailing Address - Country:US
Mailing Address - Phone:262-835-6429
Mailing Address - Fax:262-835-6433
Practice Address - Street 1:10005 NORTHWESTERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FRANKSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53126-9573
Practice Address - Country:US
Practice Address - Phone:262-835-6429
Practice Address - Fax:262-835-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI97099Medicare ID - Type Unspecified