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General NPI Number Information
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NPI Number | 1760534648
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Entity Type | Organization
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Legal Business Name | VILLAGE OF LAFARGE
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 201 S CHERRY ST
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City | LA FARGE
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State | WI
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Zip | 54639
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Country | US
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Telephone | 608-625-6147
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Fax | 608-625-2110
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Provider Business Mailing Address
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Address Line | PO BOX 327
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City | LA FARGE
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State | WI
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Zip | 54639-0327
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Country | US
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Telephone | 608-625-6147
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Fax | 608-625-2110
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Authorized Official
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Title or Position | SERVICE DIRECTOR
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Name | MR. GREGORY MICHAEL LAWTON
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Credential | EMT-BASIC
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Telephone | 608-625-6147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 6001078
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License Number State | WI
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