Provider Demographics
NPI:1205887643
Name:VILLAGE OF ASHWAUBENON
Entity type:Organization
Organization Name:VILLAGE OF ASHWAUBENON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PUBLIC SAFETY
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-492-2312
Mailing Address - Street 1:2155 HOLMGREN WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4605
Mailing Address - Country:US
Mailing Address - Phone:920-492-2312
Mailing Address - Fax:
Practice Address - Street 1:2155 HOLMGREN WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4605
Practice Address - Country:US
Practice Address - Phone:920-492-2312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012406OtherPHYSICIAN'S PLUS
8182317OtherMEDICA
022218OtherHEALTH ALLIANCE
41312400OtherMANAGED HEALTH
WI41312400Medicaid
596257081343OtherPREFERRED ONE
WI0101OtherJOHN DEERE
1012OtherNETWORK HEALTH
238438OtherHEALTH AMERICA/ASSURANCE
41312400OtherNETWORK HEALTH MAHMO
WI41312400OtherHIRSP
=========011OtherBCBS
=========011OtherMEDICARE BLUE MCHMO
8182317OtherMEDICA