Provider Demographics
NPI:1740233477
Name:NECEDAH FIRE DEPT AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:NECEDAH FIRE DEPT AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-565-2412
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:NECEDAH
Mailing Address - State:WI
Mailing Address - Zip Code:54646-0249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 CENTER ST
Practice Address - Street 2:
Practice Address - City:NECEDAH
Practice Address - State:WI
Practice Address - Zip Code:54646
Practice Address - Country:US
Practice Address - Phone:608-565-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
535678OtherDEANCARE HMO
1012592OtherPHYSICIAN'S PLUS
WI41328400Medicaid
38456OtherNETWORK HEALTH
WI0100OtherJOHN DEERE
535678OtherDEANCARE HMO
WI41328400Medicaid
=========026OtherVALLEY HEALTH PLAN
IL=========001Medicaid