Provider Demographics
NPI:1235183930
Name:XTREME CARE EMS, LLC
Entity Type:Organization
Organization Name:XTREME CARE EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-296-8165
Mailing Address - Street 1:W1662 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREEN LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54941-9029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-2214
Practice Address - Country:US
Practice Address - Phone:920-296-8165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0101OtherJOHN DEERE
WI41361000Medicaid
WI41361000Medicaid
WI0101OtherJOHN DEERE