Provider Demographics
NPI:1972093706
Name:CITY OF FORT ATKINSON
Entity Type:Organization
Organization Name:CITY OF FORT ATKINSON
Other - Org Name:FORT ATKINSON FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-563-7795
Mailing Address - Street 1:124 MILWAUKEE AVE W
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2020
Mailing Address - Country:US
Mailing Address - Phone:920-563-7795
Mailing Address - Fax:
Practice Address - Street 1:124 MILWAUKEE AVE W
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538
Practice Address - Country:US
Practice Address - Phone:920-563-7795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF FORT ATKINSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-17
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66048473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport