Provider Demographics
NPI:1174668495
Name:FREMONT- WOLF RIVER EMS,LTD.
Entity Type:Organization
Organization Name:FREMONT- WOLF RIVER EMS,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-446-2288
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-0393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:E7405 HIGHWAY 110
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:WI
Practice Address - Zip Code:54940
Practice Address - Country:US
Practice Address - Phone:920-446-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001168341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41339400Medicaid
WI41339400Medicaid