MEDICARE: DANE COUNTY PARENT COUNCIL, INC.

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	251B00000X	Case Management Agency	41863000	WI
2	163WP0200X	Pediatric Registered Nurse

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	:	1407013154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANE COUNTY PARENT COUNCIL, INC.

Provider Business Mailing Address
First Line	:	2096 RED ARROW TRL
Second Line	:
City	:	FITCHBURG
State	:	WI
Zip	:	53711-4723
Country	:	US
Telephone Number	:	608-275-6740
Fax Number	:	608-275-6756

Provider Business Practice Location Address
First Line	:	2096 RED ARROW TRL
Second Line	:
City	:	FITCHBURG
State	:	WI
Zip	:	53711-4723
Country	:	US
Telephone Number	:	608-275-6740
Fax Number	:	608-275-6756

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARCIA HUEMOELLER
Credential	:
Telephone Number	:	608-275-6740

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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