Provider Demographics
NPI:1992905418
Name:CITY OF PLYMOUTH
Entity type:Organization
Organization Name:CITY OF PLYMOUTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF EMS/SAFETY
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:920-893-1331
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:P.O. BOX 294
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-1742
Mailing Address - Country:US
Mailing Address - Phone:920-893-1331
Mailing Address - Fax:
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-1742
Practice Address - Country:US
Practice Address - Phone:920-893-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF PLYMOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-23
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60012483416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000081602Medicare PIN