Provider Demographics
NPI:1508947086
Name:CITY OF JUNEAU EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:CITY OF JUNEAU EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:RONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-386-4813
Mailing Address - Street 1:150 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039
Mailing Address - Country:US
Mailing Address - Phone:920-386-4810
Mailing Address - Fax:
Practice Address - Street 1:128 E CROSS ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039
Practice Address - Country:US
Practice Address - Phone:920-386-4810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60010743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41322400Medicaid