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General NPI Number Information
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NPI Number | 1447446299
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Entity Type | Organization
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Legal Business Name | LONG LAKE-TIPLER RESCUE SQUAD LTD
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 11098 DREAM LAKE RD
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City | TIPLER
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State | WI
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Zip | 54542
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Country | US
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Telephone | 715-889-2674
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 137
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City | LONG LAKE
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State | WI
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Zip | 54542-0137
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Country | US
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Telephone | 715-889-2674
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEE GORR
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Credential |
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Telephone | 715-889-4592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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