Healthcare Provider Details

I. General information

NPI: 1720071723
Provider Name (Legal Business Name): TOWN OF LAC DU FLAMBEAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 WILD RICE AVENUE
LAC DU FLAMBEAU WI
54538
US

IV. Provider business mailing address

PO BOX 68
LAC DU FLAMBEAU WI
54538-0068
US

V. Phone/Fax

Practice location:
  • Phone: 715-588-3358
  • Fax: 715-588-7923
Mailing address:
  • Phone: 715-588-3358
  • Fax: 715-588-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6000703
License Number StateWI

VIII. Authorized Official

Name: MRS. JANET LYNN BICKELHAUPT
Title or Position: DEPUTY TOWN CLERK
Credential:
Phone: 715-588-3358