Healthcare Provider Details

I. General information

NPI: 1730372475
Provider Name (Legal Business Name): LAONA RESCUE UNIT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5146 LINDEN ST
LAONA WI
54541
US

IV. Provider business mailing address

PO BOX 97
LAONA WI
54541-0097
US

V. Phone/Fax

Practice location:
  • Phone: 715-674-6506
  • Fax:
Mailing address:
  • Phone: 715-674-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6001126
License Number StateWI

VIII. Authorized Official

Name: DAVID MASON
Title or Position: PRESIDENT
Credential:
Phone: 715-674-4131