Healthcare Provider Details

I. General information

NPI: 1699742833
Provider Name (Legal Business Name): CITY OF SEYMOUR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 NORTH MAIN STREET
SEYMOUR WI
54165-1312
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 920-873-2209
  • Fax:
Mailing address:
  • Phone: 800-452-8191
  • Fax: 860-563-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6000322
License Number StateWI

VIII. Authorized Official

Name: MRS. MARY GENTILE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 800-452-8191