Healthcare Provider Details

I. General information

NPI: 1215957824
Provider Name (Legal Business Name): MINERAL POINT RESCUE SQUAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 RIDGE ST
MINERAL POINT WI
53565-1461
US

IV. Provider business mailing address

907 RIDGE STREET PO BOX 245
MINERAL POINT WI
53565-0245
US

V. Phone/Fax

Practice location:
  • Phone: 608-987-2752
  • Fax: 608-987-1544
Mailing address:
  • Phone: 608-987-2752
  • Fax: 608-987-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number6001292
License Number StateWI

VIII. Authorized Official

Name: RANDALL V. PROCHASKA
Title or Position: CHIEF
Credential:
Phone: 608-341-8883