Provider Demographics
NPI:1720113004
Name:WONEWOC AREA FIRE AND AMBULANCE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:WONEWOC AREA FIRE AND AMBULANCE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-464-3341
Mailing Address - Street 1:N852 BYINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WONEWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53968-9308
Mailing Address - Country:US
Mailing Address - Phone:608-464-3341
Mailing Address - Fax:
Practice Address - Street 1:200 WEST ST
Practice Address - Street 2:
Practice Address - City:WONEWOC
Practice Address - State:WI
Practice Address - Zip Code:53968-9363
Practice Address - Country:US
Practice Address - Phone:608-464-3947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000820341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41330400Medicaid
WI83508Medicare ID - Type UnspecifiedPART B