Provider Demographics
NPI:1730133299
Name:TOWN OF IXONIA
Entity Type:Organization
Organization Name:TOWN OF IXONIA
Other - Org Name:TOWN OF IXONIA FIRE & EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-261-2440
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:IXONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53036-0109
Mailing Address - Country:US
Mailing Address - Phone:920-261-2440
Mailing Address - Fax:
Practice Address - Street 1:N8320 NORTH ST
Practice Address - Street 2:
Practice Address - City:IXONIA
Practice Address - State:WI
Practice Address - Zip Code:53036-9710
Practice Address - Country:US
Practice Address - Phone:262-261-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41339600Medicaid
=========014OtherBCBS
=========014OtherVALLEY HEALTH PLAN
P00114394Medicare ID - Type UnspecifiedRAILROAD MEDICARE
000085717Medicare ID - Type UnspecifiedMEDICARE