Provider Demographics
NPI:1457332769
Name:CITY OF MANITOWOC
Entity Type:Organization
Organization Name:CITY OF MANITOWOC
Other - Org Name:MANITOWOC FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANIS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:920-686-6544
Mailing Address - Street 1:900 QUAY ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4543
Mailing Address - Country:US
Mailing Address - Phone:920-686-6544
Mailing Address - Fax:920-686-6545
Practice Address - Street 1:911 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4513
Practice Address - Country:US
Practice Address - Phone:920-686-6967
Practice Address - Fax:920-686-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41337300Medicaid
WI41337300Medicaid