Provider Demographics
NPI:1215984521
Name:DELAVAN RESCUE SQUAD INC
Entity type:Organization
Organization Name:DELAVAN RESCUE SQUAD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-728-9759
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:409 HALLBERG ST
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115
Mailing Address - Country:US
Mailing Address - Phone:262-728-9759
Mailing Address - Fax:262-728-7666
Practice Address - Street 1:651 ANN ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115
Practice Address - Country:US
Practice Address - Phone:262-728-9759
Practice Address - Fax:262-728-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41496200Medicaid