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General NPI Number Information
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NPI Number | 1194777359
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Entity Type | Organization
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Legal Business Name | CITY OF OCONOMOWOC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 212 S CONCORD RD
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3503
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Country | US
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Telephone | 262-569-3223
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Fax | 262-569-3297
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Provider Business Mailing Address
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Address Line | 212 S CONCORD RD
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3503
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Country | US
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Telephone | 262-569-3223
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Fax | 262-569-3297
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Authorized Official
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Title or Position | DEPUTY FIRE CHIEF
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Name | MR. GLENN R LEIDEL
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Credential |
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Telephone | 262-569-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 6001152
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License Number State | WI
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