MEDICARE: FALL RIVER COMMUNITY FIRE DISTRICT

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	341600000X	Ambulance	6000372	WI

General Provider Information

NPI Number	:	1578552923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALL RIVER COMMUNITY FIRE DISTRICT

Provider Business Mailing Address
First Line	:	450 SOUTH ST
Second Line	:
City	:	FALL RIVER
State	:	WI
Zip	:	53932-9404
Country	:	US
Telephone Number	:	920-484-3808
Fax Number	:	920-484-3902

Provider Business Practice Location Address
First Line	:	450 SOUTH ST
Second Line	:
City	:	FALL RIVER
State	:	WI
Zip	:	53932-9404
Country	:	US
Telephone Number	:	920-484-3808
Fax Number	:	920-484-3902

Authorized Official
Title or Position	:	EMS COORDINATOR / ASST. FIRE CHIEF
Name	:	GREGORY DENNIS BEERS
Credential	:
Telephone Number	:	920-484-3808

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/22/2020

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