Provider Demographics
NPI:1053401018
Name:CITY OF SOUTH MILWAUKEE
Entity type:Organization
Organization Name:CITY OF SOUTH MILWAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HRDLICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-768-8191
Mailing Address - Street 1:2424 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-2410
Mailing Address - Country:US
Mailing Address - Phone:414-762-2222
Mailing Address - Fax:414-762-3272
Practice Address - Street 1:2424 15TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-2410
Practice Address - Country:US
Practice Address - Phone:414-762-2222
Practice Address - Fax:414-762-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60001713416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport