Provider Demographics
NPI:1760534648
Name:VILLAGE OF LAFARGE
Entity Type:Organization
Organization Name:VILLAGE OF LAFARGE
Other - Org Name:LAFARGE AREA AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LAWTON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-BASIC
Authorized Official - Phone:608-625-6147
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:LA FARGE
Mailing Address - State:WI
Mailing Address - Zip Code:54639-0327
Mailing Address - Country:US
Mailing Address - Phone:608-625-6147
Mailing Address - Fax:608-625-2110
Practice Address - Street 1:201 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:LA FARGE
Practice Address - State:WI
Practice Address - Zip Code:54639
Practice Address - Country:US
Practice Address - Phone:608-625-6147
Practice Address - Fax:608-625-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60010783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport