Provider Demographics
NPI:1346578135
Name:UNITED EMERGENCY MEDICAL RESPONSE, LLC
Entity Type:Organization
Organization Name:UNITED EMERGENCY MEDICAL RESPONSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AMBULANCE OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:715-459-3532
Mailing Address - Street 1:3530 BOHN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6971
Mailing Address - Country:US
Mailing Address - Phone:715-459-3532
Mailing Address - Fax:715-424-6989
Practice Address - Street 1:3530 BOHN DRIVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6971
Practice Address - Country:US
Practice Address - Phone:715-459-3532
Practice Address - Fax:715-424-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66048853416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1346578135Medicaid
WI1346578135Medicaid