Healthcare Provider Details

I. General information

NPI: 1841247509
Provider Name (Legal Business Name): WALES GENESEE JOINT FIRE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S WALES RD
WALES WI
53183-9796
US

IV. Provider business mailing address

600 S WALES RD
WALES WI
53183-9796
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-3301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREG JEZAK
Title or Position: CHIEF
Credential:
Phone: 262-968-3301