Provider Demographics
NPI:1588736482
Name:CITY OF GLENWOOD CITY
Entity type:Organization
Organization Name:CITY OF GLENWOOD CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-265-4227
Mailing Address - Street 1:132 PINE ST.
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:GLENWOOD CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54013
Mailing Address - Country:US
Mailing Address - Phone:715-265-4227
Mailing Address - Fax:715-265-7307
Practice Address - Street 1:10 MISTY LANE
Practice Address - Street 2:
Practice Address - City:GLENWOOD CITY
Practice Address - State:WI
Practice Address - Zip Code:54013
Practice Address - Country:US
Practice Address - Phone:715-265-4227
Practice Address - Fax:715-265-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000572341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60572OtherAMBULANCE PROVIDER NUMBER
WI88341Medicare NSC