Provider Demographics
NPI:1952503724
Name:TOWN OF RIB MOUNTAIN
Entity Type:Organization
Organization Name:TOWN OF RIB MOUNTAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWN CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-842-0983
Mailing Address - Street 1:3700 N MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-9274
Mailing Address - Country:US
Mailing Address - Phone:715-842-0983
Mailing Address - Fax:715-848-0186
Practice Address - Street 1:3700 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-9274
Practice Address - Country:US
Practice Address - Phone:715-355-6763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41324800Medicaid