Provider Demographics
NPI:1528232832
Name:COUNTY OF WAUSHARA
Entity Type:Organization
Organization Name:COUNTY OF WAUSHARA
Other - Org Name:WAUSHARA COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PULVERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-787-6590
Mailing Address - Street 1:230 W. PARK STREET
Mailing Address - Street 2:PO BOX 837
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982
Mailing Address - Country:US
Mailing Address - Phone:920-787-6590
Mailing Address - Fax:920-787-6511
Practice Address - Street 1:230 W. PARK STREET
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982
Practice Address - Country:US
Practice Address - Phone:920-787-6590
Practice Address - Fax:920-787-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41851100Medicaid
WI43080000Medicaid
WI44013400Medicaid
WI000081871Medicare PIN