Provider Demographics
NPI:1205881760
Name:CADDOT COMMUNITY AMBULANCE VILL OF CADDOT-ARTHUR-GOETZ-SIGEL
Entity type:Organization
Organization Name:CADDOT COMMUNITY AMBULANCE VILL OF CADDOT-ARTHUR-GOETZ-SIGEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-289-3621
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:CADOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54727-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:436 E HARTFORD ST
Practice Address - Street 2:
Practice Address - City:CADOTT
Practice Address - State:WI
Practice Address - Zip Code:54727
Practice Address - Country:US
Practice Address - Phone:715-289-3621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41340800Medicaid
000088107OtherADVOCARE MCHMO
1012394OtherPHYSICIAN'S PLUS
8182554OtherMEDICA
38229OtherNETWORK HEALTH PLAN
000088107OtherTMG
WI0101OtherJOHN DEERE
8182554OtherMEDICA
=========016OtherVALLEY HEALTH PLAN
000088107Medicare ID - Type UnspecifiedMEDICARE