MEDICARE: CITY OF DELAFIELD

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	6001158	WI

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	:	1386638039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF DELAFIELD

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	:	500 GENESEE ST
Second Line	:
City	:	DELAFIELD
State	:	WI
Zip	:	53018-1817
Country	:	US
Telephone Number	:	262-646-6235
Fax Number	:	262-646-6236

Authorized Official
Title or Position	:	CPC
Name	:	MR. BALFORD FRANCIS
Credential	:
Telephone Number	:	414-423-4100

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2020

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Directions to “CITY OF DELAFIELD ” Practice Location

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