Provider Demographics
NPI:1376590208
Name:TOWN OF PLUM LAKE
Entity Type:Organization
Organization Name:TOWN OF PLUM LAKE
Other - Org Name:TOWN OF PLUM LAKE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-358-1176
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:SAYNER
Mailing Address - State:WI
Mailing Address - Zip Code:54560-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2616 STATE ROAD 155
Practice Address - Street 2:
Practice Address - City:SAYNER
Practice Address - State:WI
Practice Address - Zip Code:54560
Practice Address - Country:US
Practice Address - Phone:715-358-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1028593OtherPHYSICIAN'S PLUS
006235OtherHEALTH ALLIANCE
WI41309200Medicaid
WI0101OtherJOHN DEERE
006235OtherHEALTH ALLIANCE
1028593OtherPHYSICIAN'S PLUS