Provider Demographics
NPI:1780640250
Name:CITY OF PRINCETON
Entity Type:Organization
Organization Name:CITY OF PRINCETON
Other - Org Name:PRINCETON AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:AMBULANCE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-295-6612
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:438 WEST MAIN ST
Mailing Address - City:PRINCETON
Mailing Address - State:WI
Mailing Address - Zip Code:54968
Mailing Address - Country:US
Mailing Address - Phone:920-295-6612
Mailing Address - Fax:920-295-3441
Practice Address - Street 1:438 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WI
Practice Address - Zip Code:54968
Practice Address - Country:US
Practice Address - Phone:920-295-6612
Practice Address - Fax:920-295-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41321800Medicaid
WI82010Medicare ID - Type Unspecified