=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659313237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF WISCONSIN RAPIDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1511 12TH STREET SOUTH
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-423-1150
-----------------------------------------------------
Fax | 715-421-8280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 444 W GRAND AVE
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54495-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-421-8242
-----------------------------------------------------
Fax | 715-421-8280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIVISION CHIEF OF EMS
-----------------------------------------------------
Name | JOEL FETTERER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-421-6275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 6000044
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------