Provider Demographics
NPI:1104871441
Name:TOWN OF PRESQUE ISLE
Entity type:Organization
Organization Name:TOWN OF PRESQUE ISLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUKICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-356-2262
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:WI
Mailing Address - Zip Code:54557-0221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SCHOOL LOOP
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:WI
Practice Address - Zip Code:54557
Practice Address - Country:US
Practice Address - Phone:715-356-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41328300OtherHIRSP
31126OtherNETWORK HEALTH PLAN
WI0101OtherJOHN DEERE
WI41328300Medicaid
=========OtherTRICARE
WI0101OtherJOHN DEERE
=========019OtherBCBS