Healthcare Provider Details

I. General information

NPI: 1972557445
Provider Name (Legal Business Name): VILLAGE OF STURTEVANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 89TH ST
STURTEVANT WI
53177-2033
US

IV. Provider business mailing address

2801 89TH ST
STURTEVANT WI
53177-2033
US

V. Phone/Fax

Practice location:
  • Phone: 262-886-7224
  • Fax: 262-886-7212
Mailing address:
  • Phone: 262-886-7224
  • Fax: 262-886-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6000378
License Number StateWI

VIII. Authorized Official

Name: MR. ARTHUR M. SCOLA
Title or Position: DIRECTOR OF PUBLIC SAFETY
Credential:
Phone: 262-886-7224