MEDICARE: CITY OF WHITEWATER

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	3416L0300X	Land Ambulance	6000512	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590012061	OTHER	WI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	504844	OTHER	WI	DEAN CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154323129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF WHITEWATER

Provider Business Mailing Address
First Line	:	312 W WHITEWATER ST
Second Line	:
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1940
Country	:	US
Telephone Number	:	262-473-1381
Fax Number	:	262-473-1381

Provider Business Practice Location Address
First Line	:	312 W WHITEWATER ST
Second Line	:
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1940
Country	:	US
Telephone Number	:	262-473-0510
Fax Number	:	262-375-9608

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	JEREMIAH THOMAS
Credential	:
Telephone Number	:	262-473-1381

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/15/2025

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Directions to “CITY OF WHITEWATER ” Practice Location

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