Provider Demographics
NPI:1740231026
Name:PRAIRIE DU CHIEN RESCUE SQUAD INC
Entity type:Organization
Organization Name:PRAIRIE DU CHIEN RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KORESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-326-4441
Mailing Address - Street 1:528 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-2130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:528 S STATE ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-2130
Practice Address - Country:US
Practice Address - Phone:608-326-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0100OtherJOHN DEERE
1012582OtherPHYSICIAN'S PLUS
WI41349300Medicaid
IA0980672Medicaid
WI41349300OtherHIRSP
WI41349300OtherHIRSP
=========011OtherBCBS
1012582OtherPHYSICIAN'S PLUS
=========011OtherMEDICARE BLUE MCHMO