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General NPI Number Information
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NPI Number | 1205890621
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Entity Type | Organization
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Legal Business Name | INTERSTATE EMS OF PRAIRIE DU CHIEN, INC.
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1109 S 13TH ST
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City | PRAIRIE DU CHIEN
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State | WI
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Zip | 53821-2526
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Country | US
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Telephone | 608-326-5422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | PRAIRIE DU CHIEN
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State | WI
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Zip | 53821-0179
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Country | US
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Telephone | 608-326-5422
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Fax |
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Authorized Official
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Title or Position | EMT-INTERMEDIATE
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Name | DELORES KUSSMAUL
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Credential |
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Telephone | 608-326-5422
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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 | 6001361
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License Number State | WI
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