Provider Demographics
NPI:1407801905
Name:CITY OF CUBA CITY
Entity Type:Organization
Organization Name:CITY OF CUBA CITY
Other - Org Name:CUBA CITY AREA RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDERHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-744-8753
Mailing Address - Street 1:1031 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUBA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53807-1599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1013 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:CUBA CITY
Practice Address - State:WI
Practice Address - Zip Code:53807
Practice Address - Country:US
Practice Address - Phone:608-744-8753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1026785OtherPHYSICIAN'S PLUS
000082231OtherADVOCARE MCHMO
WI0101OtherJOHN DEERE
099305OtherHEALTH ALLIANCE
WI41357600Medicaid
WI41357600Medicaid
=========015OtherBCBS
1026785OtherPHYSICIAN'S PLUS
000082231Medicare ID - Type UnspecifiedRAILROAD MEDICARE