Provider Demographics
NPI:1760585095
Name:DANE COUNTY DISTRICT ONE EMS
Entity Type:Organization
Organization Name:DANE COUNTY DISTRICT ONE EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-795-9860
Mailing Address - Street 1:133 CRESCENT AVE
Mailing Address - Street 2:BOX 505
Mailing Address - City:MAZOMANIE
Mailing Address - State:WI
Mailing Address - Zip Code:53560-0505
Mailing Address - Country:US
Mailing Address - Phone:608-795-9860
Mailing Address - Fax:608-795-2102
Practice Address - Street 1:133 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:MAZOMANIE
Practice Address - State:WI
Practice Address - Zip Code:53560-0505
Practice Address - Country:US
Practice Address - Phone:608-795-9860
Practice Address - Fax:608-795-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-011933416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41306000Medicaid
WI41306000Medicaid