Provider Demographics
NPI:1568517688
Name:WAUSHARA COUNTY EMS
Entity Type:Organization
Organization Name:WAUSHARA COUNTY EMS
Other - Org Name:WAUSHARA COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY EMS CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:920-787-6601
Mailing Address - Street 1:N2400 S TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-8039
Mailing Address - Country:US
Mailing Address - Phone:920-787-6601
Mailing Address - Fax:920-787-0423
Practice Address - Street 1:N2400 S TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-8039
Practice Address - Country:US
Practice Address - Phone:920-787-6601
Practice Address - Fax:920-787-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60011173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI590005151OtherRAILROAD PROVIDER NUMBER
WI41337400Medicaid
WI000085451Medicare UPIN