MEDICARE: MONTFORT RESCUE SQUAD, INC.

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	146N00000X	Basic Emergency Medical Technician	6000009	WI

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	:	1588611743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTFORT RESCUE SQUAD, INC.

Provider Business Mailing Address
First Line	:	2715 W FRANK ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-2593
Country	:	US
Telephone Number	:
Fax Number	:	715-834-5870

Provider Business Practice Location Address
First Line	:	505 S WALL ST
Second Line	:
City	:	MONTFORT
State	:	WI
Zip	:	53569
Country	:	US
Telephone Number	:	608-943-6045
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	BARBARA L KROLL
Credential	:	EMT
Telephone Number	:	608-574-6848

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	11/29/2012

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