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General NPI Number Information
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NPI Number | 1114924206
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Entity Type | Organization
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Legal Business Name | LAUDERDALE-LAGRANGE FIRE DEPARTMENT, INC.
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | W6080 US HIGHWAY 12
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City | WHITEWATER
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State | WI
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Zip | 53190-4033
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Country | US
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Telephone | 262-495-8400
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Fax | 262-495-8426
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Provider Business Mailing Address
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Address Line | W6080 US HIGHWAY 12
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City | WHITEWATER
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State | WI
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Zip | 53190-4033
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Country | US
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Telephone | 262-495-4658
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Fax | 262-495-4686
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Authorized Official
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Title or Position | RESCUE CAPTAIN
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Name | MR. CHARLES TAYLOR
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Credential | EMT-I
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Telephone | 262-495-4658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 60-00522
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License Number State | WI
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