Healthcare Provider Details

I. General information

NPI: 1104830496
Provider Name (Legal Business Name): CITY OF HORICON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E LAKE ST
HORICON WI
53032-1245
US

IV. Provider business mailing address

404 E LAKE ST
HORICON WI
53032-1245
US

V. Phone/Fax

Practice location:
  • Phone: 920-485-3500
  • Fax:
Mailing address:
  • Phone: 920-485-3500
  • 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 J PASEWALD
Title or Position: CITY CLERK-TREASURER
Credential:
Phone: 920-485-3500