MEDICARE: XTREME CARE LLC

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	6600147	WI

General Provider Information

NPI Number	:	1992960413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XTREME CARE LLC

Provider Business Mailing Address
First Line	:	241 E FOLLETT ST
Second Line	:
City	:	FOND DU LAC
State	:	WI
Zip	:	54935-3542
Country	:	US
Telephone Number	:	920-960-2138
Fax Number	:

Provider Business Practice Location Address
First Line	:	W1662 NORTH ST
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-9029
Country	:	US
Telephone Number	:	920-960-2138
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DENNIS CAYWOOD
Credential	:
Telephone Number	:	920-960-2138

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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Directions to “XTREME CARE LLC ” Practice Location

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