Provider Demographics
NPI:1982659454
Name:MANITOWISH WATERS FIRE COMPANY
Entity type:Organization
Organization Name:MANITOWISH WATERS FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SKROBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-543-2373
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:MANITOWISH WATERS
Mailing Address - State:WI
Mailing Address - Zip Code:54545-0367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 W MANITOWISH WATERS RIVER ACCESS ROAD
Practice Address - Street 2:
Practice Address - City:MANITOWISH WATERS
Practice Address - State:WI
Practice Address - Zip Code:54545
Practice Address - Country:US
Practice Address - Phone:715-543-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1017946OtherPHYSICIAN'S PLUS
WI41326000Medicaid
014316OtherHEALTH ALLIANCE
WI0101OtherJOHN DEERE
=========019OtherBCBS
WI0101OtherJOHN DEERE
WI41326000Medicaid