Healthcare Provider Details

I. General information

NPI: 1477600054
Provider Name (Legal Business Name): NEWBURG FIRE DEPARTMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MAIN ST
NEWBURG WI
53060-0140
US

IV. Provider business mailing address

PO BOX 140 508 MAIN ST
NEWBURG WI
53060-0140
US

V. Phone/Fax

Practice location:
  • Phone: 262-675-6262
  • Fax:
Mailing address:
  • Phone: 262-675-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number6000373
License Number StateWI

VIII. Authorized Official

Name: MR. PAUL J. FAHEY
Title or Position: DIRECTOR
Credential:
Phone: 262-675-6262