Provider Demographics
NPI:1588715213
Name:WESTERN LAKES FIRE DISTRICT
Entity type:Organization
Organization Name:WESTERN LAKES FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-965-2262
Mailing Address - Street 1:1400 OCONOMOWOC PKWY
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4660
Mailing Address - Country:US
Mailing Address - Phone:262-965-2262
Mailing Address - Fax:262-244-7417
Practice Address - Street 1:1400 OCONOMOWOC PKWY
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4660
Practice Address - Country:US
Practice Address - Phone:262-965-2262
Practice Address - Fax:262-244-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41353300Medicaid
WI41353300Medicaid