Provider Demographics
NPI:1255529574
Name:VILLAGE OF BLANCHARDVILLE
Entity type:Organization
Organization Name:VILLAGE OF BLANCHARDVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:608-523-4321
Mailing Address - Street 1:208 MASON STREET
Mailing Address - Street 2:PO BOX 314
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516
Mailing Address - Country:US
Mailing Address - Phone:608-523-4521
Mailing Address - Fax:608-523-4321
Practice Address - Street 1:208 MASON STREET
Practice Address - Street 2:
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516
Practice Address - Country:US
Practice Address - Phone:608-523-4521
Practice Address - Fax:608-523-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41342500Medicaid
WI41342500Medicaid