=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245432731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF GREENFIELD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 06/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7325 W FOREST HOME AVE
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53220-3356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-329-5275
-----------------------------------------------------
Fax | 414-543-5713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7325 W FOREST HOME AVE
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53220-3356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-329-5275
-----------------------------------------------------
Fax | 414-543-5713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH OFFICER DIRECTOR
-----------------------------------------------------
Name | MR. DARREN RAUSCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-329-5275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------