Healthcare Provider Details

I. General information

NPI: 1851421226
Provider Name (Legal Business Name): VILLAGE OF ONTARIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 STATE ST.
ONTARIO WI
54651
US

IV. Provider business mailing address

205 STATE ST. P.O. BOX 138
ONTARIO WI
54651
US

V. Phone/Fax

Practice location:
  • Phone: 608-337-4381
  • Fax:
Mailing address:
  • Phone: 608-337-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number60-00183
License Number StateWI

VIII. Authorized Official

Name: ERIC J FERRIES
Title or Position: DIRECTOR
Credential:
Phone: 608-797-4470