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General NPI Number Information
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NPI Number | 1760585095
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Entity Type | Organization
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Legal Business Name | DANE COUNTY DISTRICT ONE EMS
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 133 CRESCENT AVE
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City | MAZOMANIE
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State | WI
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Zip | 53560-0505
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Country | US
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Telephone | 608-795-9860
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Fax | 608-795-2102
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Provider Business Mailing Address
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Address Line | 133 CRESCENT AVE BOX 505
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City | MAZOMANIE
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State | WI
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Zip | 53560-0505
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Country | US
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Telephone | 608-795-9860
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Fax | 608-795-2102
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JIM R WICK
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Credential |
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Telephone | 608-795-9860
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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 | 60-01193
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License Number State | WI
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