Provider Demographics
NPI:1831248475
Name:TOWN OF IRON RIVER
Entity type:Organization
Organization Name:TOWN OF IRON RIVER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY MEDICAL TECHNITIAN-BILLIN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY(MICKY)
Authorized Official - Middle Name:E
Authorized Official - Last Name:MULLOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:REMT
Authorized Official - Phone:715-372-8774
Mailing Address - Street 1:8285 US HIGHWAY 2
Mailing Address - Street 2:P.O. BOX 53
Mailing Address - City:IRON RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54847-3436
Mailing Address - Country:US
Mailing Address - Phone:715-372-8774
Mailing Address - Fax:715-372-4394
Practice Address - Street 1:8285 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:WI
Practice Address - Zip Code:54847-3436
Practice Address - Country:US
Practice Address - Phone:715-372-8774
Practice Address - Fax:715-372-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60007763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6000776OtherSTATE LICENSE
WI41333000Medicaid
WI000084086Medicare ID - Type UnspecifiedAMBULANCE SERVICE