Healthcare Provider Details

I. General information

NPI: 1679004030
Provider Name (Legal Business Name): MONTELLO JOINT FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 UNDERWOOD AVE
MONTELLO WI
53949-9259
US

IV. Provider business mailing address

20 UNDERWOOD AVE PO BOX 175
MONTELLO WI
53949-9259
US

V. Phone/Fax

Practice location:
  • Phone: 815-541-1477
  • Fax:
Mailing address:
  • Phone: 815-541-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: MAXINE BUSSAN
Title or Position: FISCAL AGENT
Credential:
Phone: 815-541-1477