Healthcare Provider Details

I. General information

NPI: 1942356969
Provider Name (Legal Business Name): CITY OF PLATTEVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WEST FURNACE STREET
PLATTEVILLE WI
53818
US

IV. Provider business mailing address

75 N BONSON ST PO BOX 780
PLATTEVILLE WI
53818-2502
US

V. Phone/Fax

Practice location:
  • Phone: 608-348-1835
  • Fax: 608-348-3686
Mailing address:
  • Phone: 608-348-1835
  • Fax: 608-348-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number6000101
License Number StateWI

VIII. Authorized Official

Name: BRIAN M. ALLEN
Title or Position: EMS ADMINISTRATOR
Credential: EMT-IT, EMS-I/C
Phone: 608-348-1835