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General NPI Number Information
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NPI Number | 1457689051
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Entity Type | Organization
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Legal Business Name | LAKE COUNTRY FIRE & RESCUE
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 115 MAIN STREET
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City | DELAFIELD
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State | WI
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Zip | 53018-1308
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Country | US
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Telephone | 262-646-6235
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 457
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City | WHEELING
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State | IL
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Zip | 60090-0457
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Country | US
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Telephone | 847-577-8811
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Fax | 336-510-5894
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | MATTHEW FENNIG
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Credential |
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Telephone | 262-303-4531
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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 | 6604884
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License Number State | WI
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