Provider Demographics
NPI:1235307612
Name:WAUSAUKEE RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:WAUSAUKEE RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-856-5035
Mailing Address - Street 1:P.O. BOX 318
Mailing Address - Street 2:429 HARRISON AVE
Mailing Address - City:WAUSAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:54177
Mailing Address - Country:US
Mailing Address - Phone:715-856-5035
Mailing Address - Fax:715-856-5010
Practice Address - Street 1:429 HARRISON AVE.
Practice Address - Street 2:
Practice Address - City:WAUSAUKEE
Practice Address - State:WI
Practice Address - Zip Code:54177
Practice Address - Country:US
Practice Address - Phone:715-856-5035
Practice Address - Fax:715-856-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-000913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41329000Medicaid
WI41329000Medicaid