Provider Demographics
NPI:1407928989
Name:CITY OF KIEL OFFICE OF ADMINISTRATOR
Entity Type:Organization
Organization Name:CITY OF KIEL OFFICE OF ADMINISTRATOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, KIEL AMBULANCE SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ISELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-286-0414
Mailing Address - Street 1:P.O. BOX 98
Mailing Address - Street 2:621 6TH ST
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1307
Mailing Address - Country:US
Mailing Address - Phone:920-894-2909
Mailing Address - Fax:
Practice Address - Street 1:99 EAST FREMONT ST
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042
Practice Address - Country:US
Practice Address - Phone:920-894-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-00753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41343900Medicaid
WI41343900Medicaid