MEDICARE: VILLAGE OF STURTEVANT

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	6000378	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	:	1972557445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF STURTEVANT

Provider Business Mailing Address
First Line	:	2801 89TH ST
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-2033
Country	:	US
Telephone Number	:	262-886-7224
Fax Number	:	262-886-7212

Provider Business Practice Location Address
First Line	:	2801 89TH ST
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-2033
Country	:	US
Telephone Number	:	262-886-7224
Fax Number	:	262-886-7212

Authorized Official
Title or Position	:	DIRECTOR OF PUBLIC SAFETY
Name	:	MR. ARTHUR M. SCOLA
Credential	:
Telephone Number	:	262-886-7224

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/22/2020

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Directions to “VILLAGE OF STURTEVANT ” Practice Location

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