MEDICARE: CITY OF WAUPUN

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

General Provider Information

NPI Number	:	1639002298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF WAUPUN

Provider Business Mailing Address
First Line	:	PO BOX 6253
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-6253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 E MAIN ST
Second Line	:
City	:	WAUPUN
State	:	WI
Zip	:	53963-1449
Country	:	US
Telephone Number	:	920-324-7910
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	BJ DEMAA
Credential	:
Telephone Number	:	920-324-7910

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “CITY OF WAUPUN ” Practice Location

Language	Start Address	Practice Location

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