Provider Demographics
NPI:1538114079
Name:VILLAGE OF BALDWIN
Entity Type:Organization
Organization Name:VILLAGE OF BALDWIN
Other - Org Name:BALDWIN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-684-3188
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-0138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002
Practice Address - Country:US
Practice Address - Phone:715-684-3188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41332600OtherHIRSP
7047384OtherPREFERRED ONE
000083953OtherADVOCARE MCHMO
8180302OtherMEDICA
590156514OtherRAILROAD MEDICARE
MN397267400Medicaid
WI0100OtherJOHN DEERE
1037070OtherPHYSICIAN'S PLUS
WI41332600Medicaid
=========010OtherVALLEY HEALTH PLAN
WI41332600Medicaid
000083953OtherADVOCARE MCHMO