Healthcare Provider Details

I. General information

NPI: 1467399048
Provider Name (Legal Business Name): MASON MAXWELL HORTON NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 MARKET ST APT 1
LA CROSSE WI
54601-5108
US

IV. Provider business mailing address

1626 MARKET ST APT 1
LA CROSSE WI
54601-5108
US

V. Phone/Fax

Practice location:
  • Phone: 608-421-0602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number1037811
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number70127135
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: