Provider Demographics
NPI:1720071723
Name:TOWN OF LAC DU FLAMBEAU
Entity Type:Organization
Organization Name:TOWN OF LAC DU FLAMBEAU
Other - Org Name:LAC DU FLAMBEAU AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY TOWN CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BICKELHAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-588-3358
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0068
Mailing Address - Country:US
Mailing Address - Phone:715-588-3358
Mailing Address - Fax:715-588-7923
Practice Address - Street 1:614 WILD RICE AVENUE
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538
Practice Address - Country:US
Practice Address - Phone:715-588-3358
Practice Address - Fax:715-588-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000703341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41331000Medicaid
WI=========OtherEIN