Healthcare Provider Details

I. General information

NPI: 1679526594
Provider Name (Legal Business Name): DEFOREST WINDSOR FIRE & EMS DISTRICT BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S STEVENSON ST
DEFOREST WI
53532-1513
US

IV. Provider business mailing address

PO BOX 547
WHEELING IL
60090-0547
US

V. Phone/Fax

Practice location:
  • Phone: 608-846-4364
  • Fax:
Mailing address:
  • Phone: 877-200-1191
  • Fax: 336-740-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: STEVE LAFEBER
Title or Position: CHIEF
Credential:
Phone: 608-846-4364