MEDICARE: CITY OF OCONTO

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	6001007	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	:	1760472229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF OCONTO

Provider Business Mailing Address
First Line	:	1210 MAIN ST
Second Line	:
City	:	OCONTO
State	:	WI
Zip	:	54153-1542
Country	:	US
Telephone Number	:	920-834-7711
Fax Number	:	920-834-7713

Provider Business Practice Location Address
First Line	:	1210 MAIN ST
Second Line	:
City	:	OCONTO
State	:	WI
Zip	:	54153-1542
Country	:	US
Telephone Number	:	920-834-7711
Fax Number	:	920-834-7713

Authorized Official
Title or Position	:	DEPUTY CLERK/TREASURER
Name	:	MS. CAROL F STEWART
Credential	:
Telephone Number	:	920-834-7711

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	09/19/2007

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Directions to “CITY OF OCONTO ” Practice Location

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