MEDICARE: CITY OF SUN PRAIRIE

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	6001028	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	:	1598750887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF SUN PRAIRIE

Provider Business Mailing Address
First Line	:	300 E MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2227
Country	:	US
Telephone Number	:	608-825-1192
Fax Number	:	608-834-4302

Provider Business Practice Location Address
First Line	:	2598 WEST MAIN ST.
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2247
Country	:	US
Telephone Number	:	608-837-3604
Fax Number	:	608-837-3586

Authorized Official
Title or Position	:	FINCANCE DIRECTOR/TREASURER
Name	:	MR. NATALIE M. FEGGESTAD
Credential	:
Telephone Number	:	608-825-1192

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/21/2011

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Directions to “CITY OF SUN PRAIRIE ” Practice Location

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