Organization
STONE BANK VOLUNTEER FIRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK G KLOKOW (CHIEF)
(262) 966-2414
Entity
Organization
Contact information
Practice address
W335N7107 STONEBANK RD, OCONOMOWOC, WI 53066-1407
(262) 966-2414
(262) 966-2831
Mailing address
PO BOX 72140, CEDARBURG, WI 53012-7340
(262) 375-9610
(262) 375-9608
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6001211
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41359600
—
WI
Enumeration date
05/05/2006
Last updated
09/28/2012
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