MEDICARE: CITY OF WATERLOO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1144075797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF WATERLOO

Provider Business Mailing Address
First Line	:	136 N MONROE ST
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-1125
Country	:	US
Telephone Number	:	920-478-3025
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 INDUSTRIAL LN
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-1285
Country	:	US
Telephone Number	:	920-478-2535
Fax Number	:

Authorized Official
Title or Position	:	CITY TREASURER
Name	:	LANA NELSON
Credential	:
Telephone Number	:	920-478-3025

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	04/18/2024

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Directions to “CITY OF WATERLOO ” Practice Location

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