Provider Demographics
NPI:1932215365
Name:ORFORDVILLE FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:ORFORDVILLE FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:PONKAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-879-2122
Mailing Address - Street 1:N2930 STATE ROAD 22
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-5267
Mailing Address - Country:US
Mailing Address - Phone:888-777-4911
Mailing Address - Fax:
Practice Address - Street 1:173 N WRIGHT ST
Practice Address - Street 2:
Practice Address - City:ORFORDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53576-8775
Practice Address - Country:US
Practice Address - Phone:608-879-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41307800Medicaid
WI554154OtherCOMMERCIAL
WI554154OtherCOMMERCIAL