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Organization

BLOOMFIELD GENOA CITY FIRE & RESCUE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRAD POLTERMANN (FIRE CHIEF)
(262) 279-2033
Entity
Organization

Contact information

Practice address
N 1113 CLOVER RD., PELL LAKE, WI 53157
(262) 279-2033
Mailing address
395 W LAKE ST, ELMHURST, IL 60126-1508
(630) 530-2988
(630) 903-2830

Taxonomy

Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6001223
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
396005800001
WI
01
39600580018
BCBS
WI
Enumeration date
10/23/2006
Last updated
08/22/2020
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