Provider Demographics
NPI:1821043910
Name:DELLS DELTON EMERGENCY MEDICAL SERVICES COMMISSION
Entity Type:Organization
Organization Name:DELLS DELTON EMERGENCY MEDICAL SERVICES COMMISSION
Other - Org Name:DELLS-DELTON EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-254-2159
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:LAKE DELTON
Mailing Address - State:WI
Mailing Address - Zip Code:53940-0148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 WISCONSIN DELLS PARKWAY S
Practice Address - Street 2:
Practice Address - City:LAKE DELTON
Practice Address - State:WI
Practice Address - Zip Code:53940
Practice Address - Country:US
Practice Address - Phone:608-254-2159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0572800Medicaid
MN128443600Medicaid
487393700OtherWORKER'S COMPENSATION
1042692OtherPHYSICIAN'S PLUS
WI0100OtherJOHN DEERE
95766OtherHEALTH PARTNERS
084320OtherHEALTH ALLIANCE
000081495OtherADVOCARE MCHMO
WI41359800Medicaid
MI4570350Medicaid
8181670OtherMEDICA
WI41359800Medicaid
IL=========001Medicaid
=========015OtherVALLEY HEALTH PLAN
WI0100OtherJOHN DEERE
IA0572800Medicaid
MI4570350Medicaid
=========OtherTRICARE