MEDICARE: MINERAL POINT RESCUE SQUAD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146M00000X	Intermediate Emergency Medical Technician	6001292	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215957824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINERAL POINT RESCUE SQUAD, INC.

Provider Business Mailing Address
First Line	:	907 RIDGE STREET
Second Line	:	PO BOX 245
City	:	MINERAL POINT
State	:	WI
Zip	:	53565-0245
Country	:	US
Telephone Number	:	608-987-2752
Fax Number	:	608-987-1544

Provider Business Practice Location Address
First Line	:	907 RIDGE ST
Second Line	:
City	:	MINERAL POINT
State	:	WI
Zip	:	53565-1461
Country	:	US
Telephone Number	:	608-987-2752
Fax Number	:	608-987-1544

Authorized Official
Title or Position	:	CHIEF
Name	:	RANDALL V. PROCHASKA
Credential	:
Telephone Number	:	608-341-8883

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/22/2020

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Directions to “MINERAL POINT RESCUE SQUAD, INC. ” Practice Location

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