Provider Demographics
NPI:1760461743
Name:VILLAGE OF COLFAX
Entity Type:Organization
Organization Name:VILLAGE OF COLFAX
Other - Org Name:COLFAX RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:715-962-3049
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:614C RAILROAD AVE
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-9148
Mailing Address - Country:US
Mailing Address - Phone:715-962-3049
Mailing Address - Fax:715-962-2032
Practice Address - Street 1:614C RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WI
Practice Address - Zip Code:54730-9148
Practice Address - Country:US
Practice Address - Phone:715-962-3049
Practice Address - Fax:715-962-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000760341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI590656458OtherRR MEDICARE PTAN
WI396006469Medicaid
WI000084671OtherMEDICARE PTAN