Healthcare Provider Details

I. General information

NPI: 1235183930
Provider Name (Legal Business Name): XTREME CARE EMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 S JOHNSON ST
BERLIN WI
54923-2214
US

IV. Provider business mailing address

W1662 NORTH ST
GREEN LAKE WI
54941-9029
US

V. Phone/Fax

Practice location:
  • Phone: 920-296-8165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: SUE PINKALL
Title or Position: OWNER
Credential:
Phone: 920-296-8165