Healthcare Provider Details

I. General information

NPI: 1457332769
Provider Name (Legal Business Name): CITY OF MANITOWOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 FRANKLIN ST
MANITOWOC WI
54220-4513
US

IV. Provider business mailing address

900 QUAY ST
MANITOWOC WI
54220-4543
US

V. Phone/Fax

Practice location:
  • Phone: 920-686-6967
  • Fax: 920-686-6959
Mailing address:
  • Phone: 920-686-6544
  • Fax: 920-686-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM P MANIS II
Title or Position: FIRE CHIEF
Credential:
Phone: 920-686-6544