Provider Demographics
NPI:1891745840
Name:CITY OF WAUKESHA
Entity Type:Organization
Organization Name:CITY OF WAUKESHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LA CONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-524-3668
Mailing Address - Street 1:201 DELAFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3646
Mailing Address - Country:US
Mailing Address - Phone:262-524-3556
Mailing Address - Fax:
Practice Address - Street 1:130 W ST PAUL AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-524-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000281341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0800S9500OtherFEDERAL BLACK LUNG
WI590006708OtherRR CARE
WI41350500Medicaid
WI69600S642OtherTRICARE
WI284870OtherBC BS
WI000085549Medicare ID - Type Unspecified