Provider Demographics
NPI:1740470087
Name:PRENTICE VOLUNTEER FIRE DEPARTMENT AND AMBULANCE SERVICE
Entity type:Organization
Organization Name:PRENTICE VOLUNTEER FIRE DEPARTMENT AND AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ANDREAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-428-2124
Mailing Address - Street 1:605 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PRENTICE
Mailing Address - State:WI
Mailing Address - Zip Code:54556-1125
Mailing Address - Country:US
Mailing Address - Phone:715-428-2124
Mailing Address - Fax:715-428-2120
Practice Address - Street 1:605 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PRENTICE
Practice Address - State:WI
Practice Address - Zip Code:54556-1125
Practice Address - Country:US
Practice Address - Phone:715-428-2124
Practice Address - Fax:715-428-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60003793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41334200Medicaid
WIP00206768OtherMEDICARE RAILROAD