Provider Demographics
NPI:1881647311
Name:CITY OF EAU CLAIRE
Entity type:Organization
Organization Name:CITY OF EAU CLAIRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF EMS
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-839-5024
Mailing Address - Street 1:216 S DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 S DEWEY ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3702
Practice Address - Country:US
Practice Address - Phone:715-839-5024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN693367000Medicaid
1012246OtherPHYSICIAN'S PLUS
7016775OtherPREFERRED ONE
8180068OtherMEDICA
WI41336600OtherHIRSP
WI41336600Medicaid
WI0101OtherJOHN DEERE
000085340OtherADVOCARE MCHMO
000085340OtherTMG
1863OtherNETWORK HEALTH PLAN
=========011OtherBCBS
=========011OtherVALLEY HEALTH PLAN
WI41336600OtherHIRSP
8180068OtherMEDICA
8180068OtherMEDICA
1012246OtherPHYSICIAN'S PLUS