Healthcare Provider Details

I. General information

NPI: 1508860982
Provider Name (Legal Business Name): CITY OF KAUKAUNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W. SECOND STREET
KAUKAUNA WI
54130-0890
US

IV. Provider business mailing address

201 W. SECOND STREET PO BOX 890
KAUKAUNA WI
54130-0890
US

V. Phone/Fax

Practice location:
  • Phone: 920-766-6312
  • Fax: 920-766-6339
Mailing address:
  • Phone: 920-766-6312
  • Fax: 920-766-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6000713
License Number StateWI

VIII. Authorized Official

Name: MR. PAUL HIRTE
Title or Position: FIRE CHIEF
Credential:
Phone: 920-766-6320