MEDICARE: VILLAGE OF LONE ROCK

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	341600000X	Ambulance	6000150	WI

General Provider Information

NPI Number	:	1265642938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF LONE ROCK

Provider Business Mailing Address
First Line	:	751 S PINE ST
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-4199
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 WEST UNION STREET
Second Line	:
City	:	LONE ROCK
State	:	WI
Zip	:	53556-4199
Country	:	US
Telephone Number	:	608-583-6051
Fax Number	:	608-583-6051

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL THOMAS WILSON
Credential	:
Telephone Number	:	608-604-5812

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/02/2012

Similar Medicare Providers

1578785226 — MRS. PATRICIA JEAN GRIMM R.N.
Practice Location Address:

27375 BARNETT LN
LONE ROCK, WI
53556-9000

Practice Phone: 608-647-6835
Practice Fax:

1699969626 — DR. JEN FABER D.C.
Practice Location Address:

33388 VALLEY LN
LONE ROCK, WI
53556-4149

Practice Phone: 703-300-0145
Practice Fax:

1649445370 — CHRISTINA DIANE HAHNFELD-JORDAN RN
Practice Location Address:

S10136 BEAR VALLEY RD
LONE ROCK, WI
53556-9601

Practice Phone: 608-583-2368
Practice Fax:

1730347006 — AMY ANNA JACOB COTA
Practice Location Address:

27672 ONION HOLLOW LANE
LONE ROCK, WI
53556-9002

Practice Phone: 608-475-9151
Practice Fax:

1386959245 — SOUTHWEST FAMILY CARE ALLIANCE
Practice Location Address:

28526 US HWY 14
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Practice Phone: 608-647-4729
Practice Fax: 608-649-4728

1922416460 — VALERIE ALT COTA
Practice Location Address:

205 W. BUCK RUN ROAD
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53556

Practice Phone: 608-921-0751
Practice Fax:

Directions to “VILLAGE OF LONE ROCK ” Practice Location

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