Healthcare Provider Details

I. General information

NPI: 1750815619
Provider Name (Legal Business Name): BOYCEVILLE COMMUNITY AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 RACE ST
BOYCEVILLE WI
54725-7521
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 715-643-3911
  • Fax: 715-643-3912
Mailing address:
  • Phone: 800-244-2345
  • Fax: 800-329-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6001076
License Number StateWI

VIII. Authorized Official

Name: MATTHEW J FEENEY
Title or Position: FIRE CHIEF
Credential:
Phone: 715-556-7229