Provider Demographics
NPI:1003019704
Name:FOOTVILLE FIRE DEPT & EMS
Entity Type:Organization
Organization Name:FOOTVILLE FIRE DEPT & EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-876-6118
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:FOOTVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53537-0246
Mailing Address - Country:US
Mailing Address - Phone:608-876-6118
Mailing Address - Fax:
Practice Address - Street 1:252 NORTH GILBERT STREET
Practice Address - Street 2:
Practice Address - City:FOOTVILLE
Practice Address - State:WI
Practice Address - Zip Code:53537-0246
Practice Address - Country:US
Practice Address - Phone:608-876-6118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41350800Medicaid
WI41350800Medicaid
WI000083053Medicare PIN
WI000085962Medicare PIN