Provider Demographics
NPI:1386684116
Name:VILLAGE OF PLEASANT PRAIRIE
Entity Type:Organization
Organization Name:VILLAGE OF PLEASANT PRAIRIE
Other - Org Name:PLEASANT PRAIRIE FIRE AND RESCUE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-694-8027
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:847-577-7967
Practice Address - Street 1:8044 88TH AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2015
Practice Address - Country:US
Practice Address - Phone:262-694-8027
Practice Address - Fax:262-697-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI590012289OtherRR MEDICARE
WI41352800Medicaid
WI41352800Medicaid
WI590012289OtherRR MEDICARE
WI085390Medicare PIN
WI=========OtherTRICARE NORTH