Healthcare Provider Details

I. General information

NPI: 1205827847
Provider Name (Legal Business Name): BLUE RIVER VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EXCHANGE ST
BLUE RIVER WI
53518
US

IV. Provider business mailing address

BOX 215 201 EXCHANGE ST
BLUE RIVER WI
53518
US

V. Phone/Fax

Practice location:
  • Phone: 608-537-2357
  • Fax: 608-537-2357
Mailing address:
  • Phone: 608-537-2357
  • Fax: 608-537-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6000362
License Number StateWI

VIII. Authorized Official

Name: MR. RICHARD WILLIAM LEE
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 608-537-2925