Provider Demographics
NPI:1841243896
Name:CITY OF CHIPPEWA FALLS
Entity Type:Organization
Organization Name:CITY OF CHIPPEWA FALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-726-2712
Mailing Address - Street 1:211 BAY ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 BAY ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2659
Practice Address - Country:US
Practice Address - Phone:715-723-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012453OtherPHYSICIAN'S PLUS
WI41345700Medicaid
000081087OtherTMG
WI41345700OtherHIRSP
8182929OtherMEDICA
WI0101OtherJOHN DEERE
000081087OtherADVOCARE MCHMO
MN418913200Medicaid
WI41345700OtherHIRSP
=========018OtherVALLEY HEALTH PLAN
8182929OtherMEDICA
MN418913200Medicaid