Provider Demographics
NPI:1063550820
Name:CITY OF WASHBURN
Entity type:Organization
Organization Name:CITY OF WASHBURN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-373-6160
Mailing Address - Street 1:119 WASHINGTON AVE.
Mailing Address - Street 2:P.O BOX 638
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891
Mailing Address - Country:US
Mailing Address - Phone:715-373-6160
Mailing Address - Fax:715-373-6148
Practice Address - Street 1:119 WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891
Practice Address - Country:US
Practice Address - Phone:715-373-6160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41323800146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41323800Medicaid
WI41323800Medicaid