Provider Demographics
NPI:1043267297
Name:POTOSI RESCUE SQUAD
Entity Type:Organization
Organization Name:POTOSI RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:715-832-0707
Mailing Address - Street 1:2715 WEST FRANK STREET
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:715-834-5870
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:WI
Practice Address - Zip Code:53820
Practice Address - Country:US
Practice Address - Phone:608-763-4016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41311400Medicaid