Healthcare Provider Details

I. General information

NPI: 1225085574
Provider Name (Legal Business Name): CASSVILLE RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W BLUFF ST
CASSVILLE WI
53806-9735
US

IV. Provider business mailing address

2715 W FRANK ST
EAU CLAIRE WI
54703-2593
US

V. Phone/Fax

Practice location:
  • Phone: 608-326-7828
  • Fax:
Mailing address:
  • Phone:
  • Fax: 715-834-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number6001017
License Number StateWI

VIII. Authorized Official

Name: AMY KARTMAN
Title or Position: TREASURER
Credential: EMT B
Phone: 608-725-5646