Provider Demographics
NPI:1639176258
Name:CITY OF MIDDLETON
Entity Type:Organization
Organization Name:CITY OF MIDDLETON
Other - Org Name:CITY OF MIDDLETON EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WUNSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-827-1040
Mailing Address - Street 1:7426 HUBBARD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3118
Mailing Address - Country:US
Mailing Address - Phone:608-827-1040
Mailing Address - Fax:608-827-1040
Practice Address - Street 1:2020 PARMENTER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2628
Practice Address - Country:US
Practice Address - Phone:608-827-1040
Practice Address - Fax:608-831-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60003343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41339700Medicaid
WI60201800Medicaid
WI000085730Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER