Provider Demographics
NPI:1659313237
Name:CITY OF WISCONSIN RAPIDS
Entity Type:Organization
Organization Name:CITY OF WISCONSIN RAPIDS
Other - Org Name:WISCONSIN RAPIDS FIRE DEPT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DESORCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-421-8242
Mailing Address - Street 1:444 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-2768
Mailing Address - Country:US
Mailing Address - Phone:715-421-8242
Mailing Address - Fax:715-421-8280
Practice Address - Street 1:1511 12TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494
Practice Address - Country:US
Practice Address - Phone:715-423-1150
Practice Address - Fax:715-421-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60000443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41305900Medicaid