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General NPI Number Information
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NPI Number | 1891747903
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Entity Type | Organization
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Legal Business Name | BLOOMING GROVE, BURKE, MAPLE BLUFF EMS AMBULANCE DISTRICT
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18 OXFORD PL
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City | MADISON
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State | WI
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Zip | 53704-5955
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Country | US
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Telephone | 608-244-3390
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Fax |
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Provider Business Mailing Address
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Address Line | 18 OXFORD PL
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City | MADISON
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State | WI
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Zip | 53704-5955
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF/DIRECTOR
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Name | JON ENGLEHART
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Credential |
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Telephone | 608-244-3390
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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 |
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License Number State |
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