Provider Demographics
NPI:1679004030
Name:MONTELLO JOINT FIRE DISTRICT
Entity Type:Organization
Organization Name:MONTELLO JOINT FIRE DISTRICT
Other - Org Name:MONTELLO FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-541-1477
Mailing Address - Street 1:20 UNDERWOOD AVE
Mailing Address - Street 2:PO BOX 175
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-9259
Mailing Address - Country:US
Mailing Address - Phone:815-541-1477
Mailing Address - Fax:
Practice Address - Street 1:20 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-9259
Practice Address - Country:US
Practice Address - Phone:815-541-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty