Provider Demographics
NPI:1356398267
Name:ABBOTSFORD VOLUNTEER FIRE
Entity type:Organization
Organization Name:ABBOTSFORD VOLUNTEER FIRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-223-3697
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405-0117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 E BIRCH
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405
Practice Address - Country:US
Practice Address - Phone:715-223-3697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41324200Medicaid
000080235OtherADVOCARE MCHMO
=========016OtherVALLEY HEALTH PLAN
000080235OtherADVOCARE MCHMO
P00226495Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI41324200Medicaid