Provider Demographics
NPI:1548217912
Name:OCOOCH MOUNTAIN RESCUE INC.
Entity Type:Organization
Organization Name:OCOOCH MOUNTAIN RESCUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TRESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT B
Authorized Official - Phone:608-735-4698
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:GAYS MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:54631-0204
Mailing Address - Country:US
Mailing Address - Phone:608-735-4698
Mailing Address - Fax:608-735-4040
Practice Address - Street 1:111 ROYAL AVE.
Practice Address - Street 2:
Practice Address - City:GAYS MILLS
Practice Address - State:WI
Practice Address - Zip Code:54631-0000
Practice Address - Country:US
Practice Address - Phone:608-735-4698
Practice Address - Fax:608-735-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6600149146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41360500Medicaid
WI000080625Medicare ID - Type Unspecified