Provider Demographics
NPI:1184757486
Name:COUNTY OF DOOR - DOOR COUNTY LIBRARY
Entity type:Organization
Organization Name:COUNTY OF DOOR - DOOR COUNTY LIBRARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR OF PARAMEDI
Authorized Official - Phone:920-746-7100
Mailing Address - Street 1:319 S 18TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-746-7100
Mailing Address - Fax:920-743-4917
Practice Address - Street 1:319 S 18TH AVENUE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235
Practice Address - Country:US
Practice Address - Phone:920-746-7100
Practice Address - Fax:920-743-4917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DOOR - DOOR COUNTY LIBRARY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60000193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41340300Medicaid
WI000085958Medicare ID - Type Unspecified