Provider Demographics
NPI:1366495269
Name:BRODHEAD AREA EMERGENCY MEDICAL
Entity Type:Organization
Organization Name:BRODHEAD AREA EMERGENCY MEDICAL
Other - Org Name:BRODHEAD AREA EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDERMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-897-4092
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-0014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1003 12TH ST
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-1535
Practice Address - Country:US
Practice Address - Phone:608-897-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1019784OtherPHYSICIAN'S PLUS
WI41345900OtherHIRSP
WI41345900Medicaid
000081269OtherADVOCARE MCHMO
WI0100OtherJOHN DEERE
IL=========001Medicaid
WI41345900Medicaid
WI41345900OtherHIRSP
=========016OtherVALLEY HEALTH PLAN
IL=========001Medicaid