Healthcare Provider Details

I. General information

NPI: 1154438885
Provider Name (Legal Business Name): COUNTY OF PORTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 CHURCH ST
STEVENS POINT WI
54481-3501
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 715-346-1398
  • Fax:
Mailing address:
  • Phone: 800-244-2345
  • Fax: 800-329-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL R BAKER
Title or Position: EM/EMS DIRECTOR
Credential:
Phone: 715-346-1265