Healthcare Provider Details

I. General information

NPI: 1700833167
Provider Name (Legal Business Name): CITY OF DODGEVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E FOUNTAIN ST
DODGEVILLE WI
53533-1750
US

IV. Provider business mailing address

2715 W FRANK ST
EAU CLAIRE WI
54703-2593
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-5111
  • Fax: 608-935-9477
Mailing address:
  • Phone:
  • Fax: 715-834-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number60 01312
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number60 01312
License Number StateWI

VIII. Authorized Official

Name: BRIAN CUSHMAN
Title or Position: CHIEF
Credential: EMT I
Phone: 608-935-5111