MEDICARE: EAST TROY AREA EMERGENCY SERVICES DISTRICT

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	3416L0300X	Land Ambulance	6000718	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00224238	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	41331800	OTHER	WI	H.I.R.S.P.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	41331800	OTHER	WI	WISCONSIN RENAL PROGRAM

General Provider Information

NPI Number	:	1942257381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST TROY AREA EMERGENCY SERVICES DISTRICT

Provider Business Mailing Address
First Line	:	N8406 HWY ES
Second Line	:
City	:	EAST TROY
State	:	WI
Zip	:	53120-2163
Country	:	US
Telephone Number	:	262-642-4495
Fax Number	:	262-642-2050

Provider Business Practice Location Address
First Line	:	N8406 HWY ES
Second Line	:
City	:	EAST TROY
State	:	WI
Zip	:	53120-2163
Country	:	US
Telephone Number	:	262-642-4495
Fax Number	:	262-642-2050

Authorized Official
Title or Position	:	DISTRICT BOARD CHAIRMAN
Name	:	MR. DAVE BITTER
Credential	:
Telephone Number	:	262-642-4495

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	08/22/2020

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Directions to “EAST TROY AREA EMERGENCY SERVICES DISTRICT ” Practice Location

Language	Start Address	Practice Location

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