Provider Demographics
NPI:1801882691
Name:CITY OF MONONA
Entity type:Organization
Organization Name:CITY OF MONONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE AND EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:NRP
Authorized Official - Phone:608-216-7442
Mailing Address - Street 1:5211 SCHLUTER RD
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2533
Mailing Address - Country:US
Mailing Address - Phone:608-222-2525
Mailing Address - Fax:608-222-9225
Practice Address - Street 1:5211 SCHLUTER RD
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-2533
Practice Address - Country:US
Practice Address - Phone:608-222-2525
Practice Address - Fax:608-222-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001194146M00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41313800Medicaid
WI590002965OtherRAILROAD MEDICARE
WI247688OtherBLUE CROSS BLUE SHIELD
WI41313800Medicaid