Provider Demographics
NPI:1902844368
Name:TOWN OF BRISTOL
Entity Type:Organization
Organization Name:TOWN OF BRISTOL
Other - Org Name:BRISTOL FIRE AND RESCUE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-857-2711
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-9515
Practice Address - Street 1:8301 198TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:WI
Practice Address - Zip Code:53104-9513
Practice Address - Country:US
Practice Address - Phone:262-857-2711
Practice Address - Fax:262-857-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60003853416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41355700Medicaid
WI590012077OtherMEDICARE RAILROAD
WI=========018OtherBLUE CROSS BLUE SHIELD
WI=========018OtherBLUE CROSS BLUE SHIELD
WI000082777Medicare PIN