MEDICARE: COUNTY RESCUE SERVICES, 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	3416L0300X	Land Ambulance	6001167	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	:	1730226630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY RESCUE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1765 ALLOUEZ AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5645
Country	:	US
Telephone Number	:	920-469-9779
Fax Number	:	920-469-9777

Provider Business Practice Location Address
First Line	:	1765 ALLOUEZ AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-5645
Country	:	US
Telephone Number	:	920-469-9779
Fax Number	:	920-469-9777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE ULLMER
Credential	:
Telephone Number	:	920-469-9779

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	05/03/2023

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