Healthcare Provider Details

I. General information

NPI: 1013165901
Provider Name (Legal Business Name): BIRCHWOOD FOUR CORNERS EMERGENCY SERVICES DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAIN ST
BIRCHWOOD WI
54817
US

IV. Provider business mailing address

PO BOX 6253
CAROL STREAM IL
60197-6253
US

V. Phone/Fax

Practice location:
  • Phone: 715-354-3003
  • Fax:
Mailing address:
  • Phone: 630-530-2988
  • Fax: 630-832-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6000113
License Number StateWI

VIII. Authorized Official

Name: VINCE FAIRCHILD
Title or Position: AMBULANCE DIRECTOR
Credential:
Phone: 715-939-9174