Healthcare Provider Details

I. General information

NPI: 1003840604
Provider Name (Legal Business Name): VILLAGE OF BIG BEND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W230S9185 NEVINS ST
BIG BEND WI
53103-9722
US

IV. Provider business mailing address

W230S9185 NEVINS ST
BIG BEND WI
53103-9722
US

V. Phone/Fax

Practice location:
  • Phone: 262-662-2747
  • Fax: 262-662-3751
Mailing address:
  • Phone: 262-662-2747
  • Fax: 262-662-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number67360
License Number StateWI

VIII. Authorized Official

Name: JAMES SONEBERG
Title or Position: ASSISTANT CHIEF
Credential:
Phone: 262-662-2747