=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235903899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALUMET COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2023
-----------------------------------------------------
Last Update Date | 11/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 COURT ST
-----------------------------------------------------
City | CHILTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53014-1127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-849-1432
-----------------------------------------------------
Fax | 920-849-1476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 COURT ST
-----------------------------------------------------
City | CHILTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53014-1127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-849-1432
-----------------------------------------------------
Fax | 920-849-1476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNTY ADMINISTRATOR
-----------------------------------------------------
Name | TODD ROMENESKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-849-1448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------