Provider Demographics
NPI:1295780419
Name:CAMP DOUGLAS RESCUE, INC.
Entity type:Organization
Organization Name:CAMP DOUGLAS RESCUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NEWLUN
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:608-427-3809
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:CAMP DOUGLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54618-0235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 CENTER ST
Practice Address - Street 2:
Practice Address - City:CAMP DOUGLAS
Practice Address - State:WI
Practice Address - Zip Code:54618
Practice Address - Country:US
Practice Address - Phone:608-427-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL391210787001Medicaid
WI0101OtherJOHN DEERE
000084544OtherADVOCARE MCHMO
WI41345500Medicaid
018092OtherHEALTH ALLIANCE
1012287OtherPHYSICIAN'S PLUS
WI0101OtherJOHN DEERE