Healthcare Provider Details

I. General information

NPI: 1366495269
Provider Name (Legal Business Name): BRODHEAD AREA EMERGENCY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 12TH ST
BRODHEAD WI
53520-1535
US

IV. Provider business mailing address

PO BOX 14
BRODHEAD WI
53520-0014
US

V. Phone/Fax

Practice location:
  • Phone: 608-897-4092
  • 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: BRYAN NIEDERMEIER
Title or Position: CAPTAIN
Credential:
Phone: 608-897-4092