Healthcare Provider Details

I. General information

NPI: 1154323129
Provider Name (Legal Business Name): CITY OF WHITEWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W WHITEWATER ST
WHITEWATER WI
53190-1940
US

IV. Provider business mailing address

312 W WHITEWATER ST
WHITEWATER WI
53190-1940
US

V. Phone/Fax

Practice location:
  • Phone: 262-473-0510
  • Fax: 262-375-9608
Mailing address:
  • Phone: 262-473-1381
  • Fax: 262-473-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6000512
License Number StateWI

VIII. Authorized Official

Name: JEREMIAH THOMAS
Title or Position: COMPTROLLER
Credential:
Phone: 262-473-1381