Provider Demographics
NPI:1912997248
Name:CITY OF MADISON
Entity Type:Organization
Organization Name:CITY OF MADISON
Other - Org Name:CITY OF MADISON-AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIEDICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-267-8710
Mailing Address - Street 1:210 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:RM 406
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3340
Mailing Address - Country:US
Mailing Address - Phone:608-266-4677
Mailing Address - Fax:608-261-4238
Practice Address - Street 1:325 W JOHNSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2218
Practice Address - Country:US
Practice Address - Phone:608-266-4021
Practice Address - Fax:608-267-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60003583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41313100Medicaid
WI000081463Medicare ID - Type Unspecified