Provider Demographics
NPI:1407899677
Name:CITY OF ANTIGO
Entity Type:Organization
Organization Name:CITY OF ANTIGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VOLLMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-623-3633
Mailing Address - Street 1:700 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-1955
Mailing Address - Country:US
Mailing Address - Phone:715-623-3633
Mailing Address - Fax:715-627-4761
Practice Address - Street 1:700 EDISON ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-1955
Practice Address - Country:US
Practice Address - Phone:715-623-3633
Practice Address - Fax:715-627-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-01340341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4135130Medicaid
WI590007241OtherRAILROAD MEDICARE
WI4135130Medicaid