Healthcare Provider Details

I. General information

NPI: 1205881786
Provider Name (Legal Business Name): LEBANON FIRE DEPT EMERGENCY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1738 MAIN ST
LEBANON WI
53047
US

IV. Provider business mailing address

PO BOX 82
LEBANON WI
53047-0082
US

V. Phone/Fax

Practice location:
  • Phone: 920-925-3846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MIKE UECKER
Title or Position: DIRECTOR
Credential:
Phone: 920-925-3846