Provider Demographics
NPI:1588611743
Name:MONTFORT RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:MONTFORT RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:608-574-6848
Mailing Address - Street 1:2715 W FRANK ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:715-834-5870
Practice Address - Street 1:505 S WALL ST
Practice Address - Street 2:
Practice Address - City:MONTFORT
Practice Address - State:WI
Practice Address - Zip Code:53569
Practice Address - Country:US
Practice Address - Phone:608-943-6045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000009146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41317400Medicaid
WI41317400Medicaid