Provider Demographics
NPI:1407990864
Name:POYNETTE-DEKORRA FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:POYNETTE-DEKORRA FIRE PROTECTION DISTRICT
Other - Org Name:POYNETTE DEKORRA EMERGENCY MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-635-3401
Mailing Address - Street 1:606 WATER TOWER RD.
Mailing Address - Street 2:P.O. BOX 364
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-8622
Mailing Address - Country:US
Mailing Address - Phone:608-635-3401
Mailing Address - Fax:608-635-4380
Practice Address - Street 1:606 WATER TOWER RD.
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-8622
Practice Address - Country:US
Practice Address - Phone:608-635-3401
Practice Address - Fax:608-635-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001213146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIZZ3416L0300XMedicaid
WI000081582Medicare PIN