Provider Demographics
NPI:1235273293
Name:LUXEMBURG EMERGENCY AND RESCUE SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:LUXEMBURG EMERGENCY AND RESCUE SERVICE ASSOCIATION
Other - Org Name:LUXEMBURG EMERGENCY SERVICE AND RESCUE SERVICE LUXEMBURG RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHERFF SULIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-375-9610
Mailing Address - Street 1:P.O. BOX 72140
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:262-375-9610
Mailing Address - Fax:262-375-9608
Practice Address - Street 1:331 WILLOW ST
Practice Address - Street 2:
Practice Address - City:LUXEMBURG
Practice Address - State:WI
Practice Address - Zip Code:54217-0000
Practice Address - Country:US
Practice Address - Phone:920-845-5621
Practice Address - Fax:920-845-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41309300Medicaid
WI000082197Medicare PIN