Provider Demographics
NPI:1619003662
Name:EDGAR VOLUNTEER FIRE DEPT
Entity Type:Organization
Organization Name:EDGAR VOLUNTEER FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-352-2892
Mailing Address - Street 1:108 BEECH ST
Mailing Address - Street 2:BOX NUMBER 123
Mailing Address - City:EDGAR
Mailing Address - State:WI
Mailing Address - Zip Code:54426
Mailing Address - Country:US
Mailing Address - Phone:715-352-2892
Mailing Address - Fax:715-352-8051
Practice Address - Street 1:108 BEECH ST
Practice Address - Street 2:BOX 123
Practice Address - City:EDGAR
Practice Address - State:WI
Practice Address - Zip Code:54426-0123
Practice Address - Country:US
Practice Address - Phone:715-352-2892
Practice Address - Fax:715-352-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60001193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000081761OtherMEDICARE PROVIDER PTAN
WI3416L0300XOtherMEDICAID TAXONOMY CODE
WI41327500Medicaid