Provider Demographics
NPI:1144399577
Name:DICKEYVILLE RESCUE SQUAD INC
Entity Type:Organization
Organization Name:DICKEYVILLE RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:DIETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED AEMT
Authorized Official - Phone:563-580-0130
Mailing Address - Street 1:300 SPLINTER AVE
Mailing Address - Street 2:
Mailing Address - City:DICKEYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53808-6888
Mailing Address - Country:US
Mailing Address - Phone:608-568-3095
Mailing Address - Fax:608-568-3753
Practice Address - Street 1:300 SPLINTER AVE
Practice Address - Street 2:
Practice Address - City:DICKEYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53808-6888
Practice Address - Country:US
Practice Address - Phone:608-568-3095
Practice Address - Fax:608-568-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI85201Medicare ID - Type UnspecifiedAMBULANCE