Healthcare Provider Details

I. General information

NPI: 1396016028
Provider Name (Legal Business Name): OZAUKEE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAIN ST
PORT WASHINGTON WI
53074-1813
US

IV. Provider business mailing address

121 W MAIN ST
PORT WASHINGTON WI
53074-1813
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-8200
  • Fax: 262-284-8103
Mailing address:
  • Phone: 262-284-8200
  • Fax: 262-284-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANNE F CONNERS
Title or Position: FINANCIAL ANALYST
Credential: CPA
Phone: 262-284-8200