MEDICARE: VILLAGE OF WILTON

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	6001019	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	:	1629143474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF WILTON

Provider Business Mailing Address
First Line	:	400 EAST ST STE 103
Second Line	:
City	:	WILTON
State	:	WI
Zip	:	54670-7735
Country	:	US
Telephone Number	:	608-435-6666
Fax Number	:	608-435-6692

Provider Business Practice Location Address
First Line	:	400 EAST ST STE 103
Second Line	:
City	:	WILTON
State	:	WI
Zip	:	54670-7735
Country	:	US
Telephone Number	:	608-435-6666
Fax Number	:	608-435-6692

Authorized Official
Title or Position	:	VILLAGE CLERK TREASURER
Name	:	LORI BRUEGGEN
Credential	:
Telephone Number	:	608-435-6666

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/21/2013

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Directions to “VILLAGE OF WILTON ” Practice Location

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