Healthcare Provider Details

I. General information

NPI: 1396892451
Provider Name (Legal Business Name): MILWAUKEE COUNTY OEM-EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N 9TH ST
MILWAUKEE WI
53233-1425
US

IV. Provider business mailing address

633 W. WISCONSIN AVE SUITE 700
MILWAUKEE WI
53203
US

V. Phone/Fax

Practice location:
  • Phone: 414-289-5949
  • Fax:
Mailing address:
  • Phone: 414-226-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number6001239
License Number StateWI

VIII. Authorized Official

Name: MRS. CASSANDRA L. LIBAL
Title or Position: DIRECTOR
Credential:
Phone: 414-226-7303