Provider Demographics
NPI:1750338760
Name:TOWN OF ELCHO
Entity type:Organization
Organization Name:TOWN OF ELCHO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-275-4456
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:W10587 COUNTY RD K
Mailing Address - City:ELCHO
Mailing Address - State:WI
Mailing Address - Zip Code:54428-0213
Mailing Address - Country:US
Mailing Address - Phone:715-275-4456
Mailing Address - Fax:715-275-4662
Practice Address - Street 1:W10587 COUNTY ROAD K
Practice Address - Street 2:
Practice Address - City:ELCHO
Practice Address - State:WI
Practice Address - Zip Code:54428
Practice Address - Country:US
Practice Address - Phone:715-275-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66001513416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41360200Medicaid
000082290OtherADVOCARE MCHMO
=========012OtherVALLEY HEALTH PLAN
000082290OtherADVOCARE MCHMO
WI000082290Medicare PIN
000082290OtherADVOCARE MCHMO
=========012OtherVALLEY HEALTH PLAN