MEDICARE: LUXEMBURG EMERGENCY AND RESCUE SERVICE ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235273293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXEMBURG EMERGENCY AND RESCUE SERVICE ASSOCIATION

Provider Business Mailing Address
First Line	:	P.O. BOX 72140
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53226
Country	:	US
Telephone Number	:	262-375-9610
Fax Number	:	262-375-9608

Provider Business Practice Location Address
First Line	:	331 WILLOW ST
Second Line	:
City	:	LUXEMBURG
State	:	WI
Zip	:	54217-0000
Country	:	US
Telephone Number	:	920-845-5621
Fax Number	:	920-845-5625

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MICHELLE L SCHERFF SULIK
Credential	:
Telephone Number	:	262-375-9610

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	11/20/2012

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