Healthcare Provider Details

I. General information

NPI: 1235273293
Provider Name (Legal Business Name): LUXEMBURG EMERGENCY AND RESCUE SERVICE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WILLOW ST
LUXEMBURG WI
54217-0000
US

IV. Provider business mailing address

P.O. BOX 72140
CEDARBURG WI
53226
US

V. Phone/Fax

Practice location:
  • Phone: 920-845-5621
  • Fax: 920-845-5625
Mailing address:
  • Phone: 262-375-9610
  • Fax: 262-375-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELLE L SCHERFF SULIK
Title or Position: BILLING MANAGER
Credential:
Phone: 262-375-9610