Provider Demographics
NPI:1447201611
Name:PITTSVILLE VOL FIRE DEPT INC
Entity Type:Organization
Organization Name:PITTSVILLE VOL FIRE DEPT INC
Other - Org Name:PITTSVILLE FIRE DEPT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-884-6514
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-0241
Mailing Address - Country:US
Mailing Address - Phone:715-884-6514
Mailing Address - Fax:
Practice Address - Street 1:5388 4TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-9342
Practice Address - Country:US
Practice Address - Phone:715-884-6514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41341100Medicaid
WI0101OtherJOHN DEERE
MN2165155-00Medicaid
000088307OtherADVOCARE MC HMO
1012447OtherPHYSICIAN'S PLUS
WI41341100Medicaid
IL=========001Medicaid
=========019OtherMEDICARE BLUE MCHMO
MN2165155-00Medicaid
WI41341100Medicaid
WI000088307Medicare ID - Type UnspecifiedMEDICARE