City of Bloomer
Organization Active NPI Ambulance · Bloomer, WI
NPI 1912196700 · NPPES record last updated Jun 11, 2008
Key facts
- NPI
- 1912196700
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- Legal business name
- CITY OF BLOOMER
- Practice address
- 1200 15TH Ave
Bloomer, WI 54724-1613 - Phone
- (715) 838-8898
- Fax
- (715) 838-8895
- NPI assigned
- Oct 17, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- CITY OF BLOOMER
Authorized official
- Name
- Vici J Mobraaten
- Title
- Billing Manager
- Phone
- (715) 838-8898
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120514000156 | WI | Part B Supplier - Ambulance Service Supplier | 8729241674 | Practice locations: Bloomer, WI |
National Provider Directory
- Part of
- City of Bloomer
Locations
1630 Oak St
Bloomer, WI 54724
Phone (715) 568-5554
1200 15th Ave
Bloomer, WI 54724
Phone (715) 838-8898
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | WI | Yes |
Addresses
Primary practice location
1200 15TH Ave
Bloomer, WI 54724-1613
Mailing address
1200 15TH Ave
Bloomer, WI 54724-1613
Phone (715) 838-8898
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41339300 | Medicaid | WI |
Other names
- Bloomer Community Ambulance Svc
Other providers in Bloomer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.