MEDICARE: CITY OF WATERLOO

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	552613	OTHER	WI	COMMERCIAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538276266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF WATERLOO

Provider Business Mailing Address
First Line	:	PO BOX 72140
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-7340
Country	:	US
Telephone Number	:	262-375-9610
Fax Number	:	262-375-9608

Provider Business Practice Location Address
First Line	:	900 INDUSTRIAL LN
Second Line	:
City	:	WATERLOO
State	:	WI
Zip	:	53594-1285
Country	:	US
Telephone Number	:	920-478-2535
Fax Number	:	920-478-9597

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHELLE L SCHERFF SULIK
Credential	:
Telephone Number	:	262-375-9610

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	12/10/2010

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Directions to “CITY OF WATERLOO ” Practice Location

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