Provider Demographics
NPI:1215989223
Name:VILLAGE OF WESTON
Entity type:Organization
Organization Name:VILLAGE OF WESTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-355-5419
Mailing Address - Street 1:5303 MESKER ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-4304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5303 MESKER ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4304
Practice Address - Country:US
Practice Address - Phone:715-355-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41317800Medicaid
WI0101OtherJOHN DEERE
WI41317800OtherHIRSP
1024723OtherPHYSICIAN'S PLUS
41317800OtherNETWORK HEALTH
1024723OtherPHYSICIAN'S PLUS
=========010OtherBCBS
WI41317800Medicaid