Healthcare Provider Details

I. General information

NPI: 1649812041
Provider Name (Legal Business Name): VILLAGE OF CAMP DOUGLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 CENTER ST
CAMP DOUGLAS WI
54618-2800
US

IV. Provider business mailing address

PO BOX 200
CAMP DOUGLAS WI
54618-0200
US

V. Phone/Fax

Practice location:
  • Phone: 608-427-3809
  • Fax:
Mailing address:
  • Phone: 608-542-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES CHARLES NEWLUN
Title or Position: FIRE CHIEF
Credential: AEMT
Phone: 608-427-3809