Provider Demographics
NPI:1417668468
Name:SOUTHERN OZAUKEE FIRE AND EMERGENCY MEDICAL SERVICES DEPARTMENT
Entity Type:Organization
Organization Name:SOUTHERN OZAUKEE FIRE AND EMERGENCY MEDICAL SERVICES DEPARTMENT
Other - Org Name:SOUTHERN OZAUKEE FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:BATTALION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-242-8784
Mailing Address - Street 1:11300 N BUNTROCK AVE
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1843
Mailing Address - Country:US
Mailing Address - Phone:262-242-2530
Mailing Address - Fax:
Practice Address - Street 1:11300 N BUNTROCK AVE
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-1843
Practice Address - Country:US
Practice Address - Phone:262-242-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6605038OtherSTATE OF WI EMS SERVICE LICENSE