Healthcare Provider Details

I. General information

NPI: 1265546600
Provider Name (Legal Business Name): VILLAGE OF CAMPBELLSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 E MAIN ST
CAMPBELLSPORT WI
53010
US

IV. Provider business mailing address

PO BOX 72140
CEDARBURG WI
53012-7340
US

V. Phone/Fax

Practice location:
  • Phone: 920-533-5266
  • Fax:
Mailing address:
  • Phone: 262-375-9610
  • 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: MR. DAVID SULIK
Title or Position: BILLING MANAGER
Credential:
Phone: 262-375-9610