Provider Demographics
NPI:1225085483
Name:FENNIMORE AREA RESCUE SQUAD INC
Entity Type:Organization
Organization Name:FENNIMORE AREA RESCUE SQUAD INC
Other - Org Name:FENNIMORE RURAL FIRE DEPARTMENT RESCUE SQUAD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:608-778-8482
Mailing Address - Street 1:2715 WEST FRANK STREET
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:715-834-5870
Practice Address - Street 1:1070 8TH STREET
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809
Practice Address - Country:US
Practice Address - Phone:608-822-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41360400Medicaid