Provider Demographics
NPI:1811913312
Name:BURLINGTON RESCUE SQUAD, INC.
Entity type:Organization
Organization Name:BURLINGTON RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:O
Authorized Official - Last Name:MASTLIR
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:262-763-9521
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-0501
Mailing Address - Country:US
Mailing Address - Phone:262-763-9521
Mailing Address - Fax:262-763-9521
Practice Address - Street 1:165 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1445
Practice Address - Country:US
Practice Address - Phone:262-763-9521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1213-8003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41332000Medicaid
WI83-886Medicare ID - Type UnspecifiedMEDICARE