Provider Demographics
NPI:1760438246
Name:CITY OF LAKE GENEVA
Entity Type:Organization
Organization Name:CITY OF LAKE GENEVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-248-3673
Mailing Address - Street 1:626 GENEVA ST
Mailing Address - Street 2:CITY HALL
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1914
Mailing Address - Country:US
Mailing Address - Phone:262-248-3673
Mailing Address - Fax:262-248-4715
Practice Address - Street 1:730 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1436
Practice Address - Country:US
Practice Address - Phone:262-248-3673
Practice Address - Fax:262-248-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport