Provider Demographics
NPI:1578776811
Name:IOLA AND RURAL FIRE DEPARTMENT AND AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:IOLA AND RURAL FIRE DEPARTMENT AND AMBULANCE SERVICE, INC.
Other - Org Name:IOLA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:715-445-2515
Mailing Address - Street 1:350 W IOLA ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9652
Mailing Address - Country:US
Mailing Address - Phone:715-445-2515
Mailing Address - Fax:715-445-3130
Practice Address - Street 1:350 W IOLA ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9652
Practice Address - Country:US
Practice Address - Phone:715-445-2515
Practice Address - Fax:715-445-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60004783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41340500Medicaid
WI41340500Medicaid