Provider Demographics
NPI:1073375804
Name:PICKEREL RESCUE SQUAD, INC
Entity Type:Organization
Organization Name:PICKEREL RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT,RN
Authorized Official - Phone:715-216-1120
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:PICKEREL
Mailing Address - State:WI
Mailing Address - Zip Code:54465-0047
Mailing Address - Country:US
Mailing Address - Phone:715-216-1120
Mailing Address - Fax:715-484-7700
Practice Address - Street 1:N9062 STATE HWY 55
Practice Address - Street 2:
Practice Address - City:PICKEREL
Practice Address - State:WI
Practice Address - Zip Code:54465
Practice Address - Country:US
Practice Address - Phone:715-216-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty