Provider Demographics
NPI:1629143474
Name:VILLAGE OF WILTON
Entity Type:Organization
Organization Name:VILLAGE OF WILTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VILLAGE CLERK TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUEGGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-435-6666
Mailing Address - Street 1:400 EAST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:WI
Mailing Address - Zip Code:54670-7735
Mailing Address - Country:US
Mailing Address - Phone:608-435-6666
Mailing Address - Fax:608-435-6692
Practice Address - Street 1:400 EAST ST STE 103
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:WI
Practice Address - Zip Code:54670-7735
Practice Address - Country:US
Practice Address - Phone:608-435-6666
Practice Address - Fax:608-435-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60010193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41328200Medicaid
WI83044Medicare ID - Type UnspecifiedPROVIDER NUMBER