Provider Demographics
NPI:1205827847
Name:BLUE RIVER VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD
Entity Type:Organization
Organization Name:BLUE RIVER VOLUNTEER FIRE DEPARTMENT & RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-537-2925
Mailing Address - Street 1:BOX 215
Mailing Address - Street 2:201 EXCHANGE ST
Mailing Address - City:BLUE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53518
Mailing Address - Country:US
Mailing Address - Phone:608-537-2357
Mailing Address - Fax:608-537-2357
Practice Address - Street 1:201 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:BLUE RIVER
Practice Address - State:WI
Practice Address - Zip Code:53518
Practice Address - Country:US
Practice Address - Phone:608-537-2357
Practice Address - Fax:608-537-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60003623416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI562830OtherDEAN HEALTH PLAN, INC.
WI41358700Medicaid
WI562830OtherDEAN HEALTH PLAN, INC.
WI562830OtherDEAN HEALTH PLAN, INC.