=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215974571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF ELKHORN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 08/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 S BROAD ST
-----------------------------------------------------
City | ELKHORN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53121-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-723-5080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 445
-----------------------------------------------------
City | ELKHORN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53121-0445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-723-5080
-----------------------------------------------------
Fax | 262-723-2846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS CHIEF
-----------------------------------------------------
Name | DAVID J FLADTEN
-----------------------------------------------------
Credential | NREMT-P, CCEM
-----------------------------------------------------
Telephone | 262-723-5080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 6000717
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------