=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336254291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF BERLIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 06/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 N CAPRON ST
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54923-1512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-361-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 N CAPRON ST PO BOX 272
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54923-1512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-361-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DEE M EVANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-361-5343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 6000710
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------