Provider Demographics
NPI:1942356969
Name:CITY OF PLATTEVILLE
Entity Type:Organization
Organization Name:CITY OF PLATTEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-IT, EMS-I/C
Authorized Official - Phone:608-348-1835
Mailing Address - Street 1:75 N BONSON ST
Mailing Address - Street 2:PO BOX 780
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-2502
Mailing Address - Country:US
Mailing Address - Phone:608-348-1835
Mailing Address - Fax:608-348-3686
Practice Address - Street 1:330 WEST FURNACE STREET
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-348-1835
Practice Address - Fax:608-348-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000101146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI83889OtherPROVIDER NUMBER