MEDICARE: VILLAGE OF MOUNT PLEASANT

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	6001064	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518071927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF MOUNT PLEASANT

Provider Business Mailing Address
First Line	:	PO BOX 72140
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-7340
Country	:	US
Telephone Number	:	262-375-9610
Fax Number	:	262-375-9608

Provider Business Practice Location Address
First Line	:	3900 OLD GREEN BAY ROAD
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-9488
Country	:	US
Telephone Number	:	262-554-8812
Fax Number	:	262-554-6785

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. MICHELLE SCHERFF SULIK
Credential	:
Telephone Number	:	262-375-9610

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	06/03/2011

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Directions to “VILLAGE OF MOUNT PLEASANT ” Practice Location

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