Provider Demographics
NPI:1679784029
Name:VILLAGE OF CAMBRIA
Entity Type:Organization
Organization Name:VILLAGE OF CAMBRIA
Other - Org Name:CAMBRIA COMMUNITY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-348-5443
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:111 W EDGEWATER STREET
Mailing Address - City:CAMBRIA
Mailing Address - State:WI
Mailing Address - Zip Code:53923-0295
Mailing Address - Country:US
Mailing Address - Phone:920-348-5443
Mailing Address - Fax:920-348-6050
Practice Address - Street 1:702 ELIZABETH STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:WI
Practice Address - Zip Code:53923
Practice Address - Country:US
Practice Address - Phone:920-348-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF CAMBRIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-25
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001091341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41325700Medicaid
WI41325700Medicaid