Provider Demographics
NPI:1508810102
Name:CITY OF PORT WASHINGTON
Entity Type:Organization
Organization Name:CITY OF PORT WASHINGTON
Other - Org Name:CITY OF PORT WASHINGTON FIRE DEPT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-284-2891
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-0307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1830
Practice Address - Country:US
Practice Address - Phone:262-284-2891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000082642OtherADVOCARE MCHMO
015915OtherHEALTH ALLIANCE
0000005721OtherVITAS HEALTHCARE CORP
WI0101OtherJOHN DEERE
1014456OtherPHYSICIAN'S PLUS
WI41305000Medicaid
WI41305000OtherHIRSP
IL=========001Medicaid
WI0101OtherJOHN DEERE
0000005721OtherVITAS HEALTHCARE CORP
IL=========001Medicaid
015915OtherHEALTH ALLIANCE