Healthcare Provider Details

I. General information

NPI: 1184671448
Provider Name (Legal Business Name): FOX LAKE COMMUNITY FIRE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E STATE ST
FOX LAKE WI
53933-8027
US

IV. Provider business mailing address

W8542 LAUREL HILL RD
FOX LAKE WI
53933-9739
US

V. Phone/Fax

Practice location:
  • Phone: 920-928-6115
  • Fax:
Mailing address:
  • Phone: 920-928-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6000139
License Number StateWI

VIII. Authorized Official

Name: MR. RUSSELL KOTTKE
Title or Position: SECRETARY TREASURER
Credential:
Phone: 920-960-7754