Healthcare Provider Details

I. General information

NPI: 1922100171
Provider Name (Legal Business Name): CROSS PLAINS AREA EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 PARK ST
CROSS PLAINS WI
53528-9610
US

IV. Provider business mailing address

PO BOX 72140
CEDARBURG WI
53012-7340
US

V. Phone/Fax

Practice location:
  • Phone: 608-798-2720
  • Fax:
Mailing address:
  • Phone: 262-375-9610
  • Fax: 262-375-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6001351
License Number StateWI

VIII. Authorized Official

Name: MR. DAVID R SULIK
Title or Position: BILLING MANAGER
Credential:
Phone: 262-375-9610