MEDICARE: VILLAGE OF HARTLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance
2	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134102932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF HARTLAND

Provider Business Mailing Address
First Line	:	6400 INDUSTRIAL LOOP
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2452
Country	:	US
Telephone Number	:	414-423-4100
Fax Number	:	414-423-4134

Provider Business Practice Location Address
First Line	:	150 LAWN ST
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-1714
Country	:	US
Telephone Number	:	262-367-2714
Fax Number	:	262-367-2430

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	RYAN BAILEY
Credential	:	CPA
Telephone Number	:	262-367-2714

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	09/30/2013

Similar Medicare Providers

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Practice Location Address:

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1184603755 — FAWAD KHAN MD
Practice Location Address:

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1912979451 — JOHN C LESNIAK M.D.
Practice Location Address:

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1093788309 — KARIN I KULTGEN M.D.
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1013980234 — BETH G KEEFE M.D.
Practice Location Address:

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Directions to “VILLAGE OF HARTLAND ” Practice Location

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