Provider Demographics
NPI:1588618920
Name:LODI AREA EMS
Entity Type:Organization
Organization Name:LODI AREA EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-592-7123
Mailing Address - Street 1:715 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-1259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1259
Practice Address - Country:US
Practice Address - Phone:608-592-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012184OtherPHYSICIAN'S PLUS
WI41315900OtherHIRSP
WI41315900Medicaid
=========012OtherVALLEY HEALTH PLAN
1012184OtherPHYSICIAN'S PLUS