Provider Demographics
NPI:1164552105
Name:SPENCER AREA FIRE AND AMBULANCE COMMISSION
Entity Type:Organization
Organization Name:SPENCER AREA FIRE AND AMBULANCE COMMISSION
Other - Org Name:SPENCER FIRE DEPARTMENT AND AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:B
Authorized Official - Last Name:FOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-659-4030
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:206 W WILLOW DRIVE
Mailing Address - City:SPENCER
Mailing Address - State:WI
Mailing Address - Zip Code:54479-9552
Mailing Address - Country:US
Mailing Address - Phone:715-659-4030
Mailing Address - Fax:715-659-4106
Practice Address - Street 1:206 W WILLOW DRIVE
Practice Address - Street 2:206 W WILLOW DRIVE
Practice Address - City:SPENCER
Practice Address - State:WI
Practice Address - Zip Code:54479-9552
Practice Address - Country:US
Practice Address - Phone:715-659-4030
Practice Address - Fax:715-659-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94083341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41333700Medicaid
WI41333700Medicaid