Healthcare Provider Details

I. General information

NPI: 1528011657
Provider Name (Legal Business Name): VILLAGE OF CLEAR LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 3RD AVE
CLEAR LAKE WI
54005-8905
US

IV. Provider business mailing address

PO BOX 215
CLEAR LAKE WI
54005-0215
US

V. Phone/Fax

Practice location:
  • Phone: 715-263-2804
  • Fax:
Mailing address:
  • Phone:
  • 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: MISTY WOOD
Title or Position: DIRECTOR/RN
Credential: RN
Phone: 602-670-1386