Village of Lisbon

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

6001261 Issued in WI

Legal business name

VILLAGE OF LISBON

Doing business as

Town of Lisbon Emergency Medical Town of Lisbon Fire Department

Practice address

N72 W24958 Good Hope Road
Sussex, WI 53089

Phone

(262) 538-3902

Fax

(262) 820-2030

NPI assigned

Aug 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathy Nickolaus

Title

Administrator

Phone

(262) 246-6100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Town of Lisbon Emergency Medical Town of Lisbon Fire Department Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717632000000",
    "number": "1568475895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W234 N8676 WOODSIDE ROAD",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530891545",
            "telephone_number": "262-246-6100",
            "fax_number": "262-820-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N72 W24958 GOOD HOPE ROAD",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "53089",
            "telephone_number": "262-538-3902",
            "fax_number": "262-820-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF LISBON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "NICKOLAUS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "262-246-6100"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "6001261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41315400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Town of Lisbon Emergency Medical Town of Lisbon Fire Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victoria Lynn Tyra, RN, FNP-C
• Bradley A Tythcott, PT
• Rick L. Vaniperen, R.PH , M.B.A
• Vezzetti Family Dental Care
• Mary Vezzetti, DDS
• Village of Sussex
• Kirsten Marie Virnig, LMT
• Quynh Vo, PHARM.D
• Linda S Vogel, P.A
• Randal Leonard Vosters, MD

• Land Ambulance in Sussex, WI
• Providers in Sussex, WI by specialty
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.