Healthcare Provider Details

I. General information

NPI: 1124296926
Provider Name (Legal Business Name): CAZENOVIA FD RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 STATE HWY 58 NORTH 310 HWY 58 NORTH
CAZENOVIA WI
53924-0183
US

IV. Provider business mailing address

401 STATE HWY 58 NORTH PO BOX 183
CAZENOVIA WI
53924-0183
US

V. Phone/Fax

Practice location:
  • Phone: 608-983-2840
  • Fax: 608-983-2215
Mailing address:
  • Phone: 608-983-2840
  • Fax: 608-983-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number60-00515
License Number StateWI

VIII. Authorized Official

Name: MRS. BONNIE L MARSHALL
Title or Position: BOOKKEEPER-SECRETARY
Credential:
Phone: 608-983-2840