Provider Demographics
NPI:1649812041
Name:VILLAGE OF CAMP DOUGLAS
Entity type:Organization
Organization Name:VILLAGE OF CAMP DOUGLAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NEWLUN
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:608-427-3809
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:CAMP DOUGLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54618-0200
Mailing Address - Country:US
Mailing Address - Phone:608-542-0346
Mailing Address - Fax:
Practice Address - Street 1:304 CENTER ST
Practice Address - Street 2:
Practice Address - City:CAMP DOUGLAS
Practice Address - State:WI
Practice Address - Zip Code:54618-2800
Practice Address - Country:US
Practice Address - Phone:608-427-3809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6604999OtherBLS EMS LICENSE