Provider Demographics
NPI:1568679934
Name:SHIOCTON-BOVINA FIRE DEPARTMENT
Entity Type:Organization
Organization Name:SHIOCTON-BOVINA FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-986-3232
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:SHIOCTON
Mailing Address - State:WI
Mailing Address - Zip Code:54170-0238
Mailing Address - Country:US
Mailing Address - Phone:920-986-3232
Mailing Address - Fax:920-986-3743
Practice Address - Street 1:W7746 PINE STREET
Practice Address - Street 2:
Practice Address - City:SHIOCTON
Practice Address - State:WI
Practice Address - Zip Code:54170
Practice Address - Country:US
Practice Address - Phone:920-986-3232
Practice Address - Fax:920-986-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-00894341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41322100Medicaid
WI82100Medicare ID - Type Unspecified