Healthcare Provider Details

I. General information

NPI: 1669795811
Provider Name (Legal Business Name): CAZENOVIA AREA WORLD FIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 STATE HIGHWAY 58 NORTH
CAZENOVIA WI
53924-0183
US

IV. Provider business mailing address

PO BOX 183
CAZENOVIA WI
53924-0183
US

V. Phone/Fax

Practice location:
  • Phone: 608-983-2840
  • Fax: 608-983-2019
Mailing address:
  • Phone: 608-983-2840
  • Fax: 608-983-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BONNIE L MARSHALL
Title or Position: SECRETARY-BOOKEEPER
Credential:
Phone: 16089832840