Provider Demographics
NPI:1669475331
Name:CITY OF NEW BERLIN
Entity Type:Organization
Organization Name:CITY OF NEW BERLIN
Other - Org Name:CITY OF NEW BERLIN FIRE DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASST CHIEF- EMS DIVISION
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-785-6120
Mailing Address - Street 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:262-567-5171
Mailing Address - Fax:414-423-4134
Practice Address - Street 1:16300 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5510
Practice Address - Country:US
Practice Address - Phone:262-785-6120
Practice Address - Fax:262-785-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-00110146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41358200Medicaid
WI=========001Medicaid
WI41358200Medicaid
WI590015442 5900015442Medicare ID - Type UnspecifiedMEDICARE- RAILROAD
WI=========010OtherBLUE CROSS/ BLUE SHIELD
WI=========001Medicaid