Healthcare Provider Details

I. General information

NPI: 1255529574
Provider Name (Legal Business Name): VILLAGE OF BLANCHARDVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MASON STREET
BLANCHARDVILLE WI
53516
US

IV. Provider business mailing address

208 MASON STREET PO BOX 314
BLANCHARDVILLE WI
53516
US

V. Phone/Fax

Practice location:
  • Phone: 608-523-4521
  • Fax: 608-523-4321
Mailing address:
  • Phone: 608-523-4521
  • Fax: 608-523-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LAURA ELLEN PALMER
Title or Position: DIRECTOR / CHIEF
Credential: AEMT
Phone: 608-523-4321