Healthcare Provider Details

I. General information

NPI: 1760534648
Provider Name (Legal Business Name): VILLAGE OF LAFARGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S CHERRY ST
LA FARGE WI
54639
US

IV. Provider business mailing address

PO BOX 327
LA FARGE WI
54639-0327
US

V. Phone/Fax

Practice location:
  • Phone: 608-625-6147
  • Fax: 608-625-2110
Mailing address:
  • Phone: 608-625-6147
  • Fax: 608-625-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6001078
License Number StateWI

VIII. Authorized Official

Name: MR. GREGORY MICHAEL LAWTON
Title or Position: SERVICE DIRECTOR
Credential: EMT-BASIC
Phone: 608-625-6147