Healthcare Provider Details

I. General information

NPI: 1942285911
Provider Name (Legal Business Name): NIAGARA AREA EMERGENCY UNIT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 JACKSON ST
NIAGARA WI
54151-1233
US

IV. Provider business mailing address

PO BOX 66
NIAGARA WI
54151-0066
US

V. Phone/Fax

Practice location:
  • Phone: 715-251-3136
  • Fax: 715-251-3136
Mailing address:
  • Phone: 715-251-3136
  • Fax: 715-251-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6001089
License Number StateWI

VIII. Authorized Official

Name: MR. ANDREW CLETUS RABIDEAU
Title or Position: BILLER
Credential: EMT-B
Phone: 715-251-3136