Healthcare Provider Details

I. General information

NPI: 1356392625
Provider Name (Legal Business Name): DEER-GROVE EMS DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 COUNTY RD N
COTTAGE GROVE WI
53527-8305
US

IV. Provider business mailing address

4030 COUNTY RD N
COTTAGE GROVE WI
53527-8305
US

V. Phone/Fax

Practice location:
  • Phone: 608-839-5658
  • 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: JESS ROBINSON
Title or Position: CHIEF
Credential:
Phone: 608-839-5658