Provider Demographics
NPI:1831185420
Name:HEALTH LINE RESOURCES
Entity type:Organization
Organization Name:HEALTH LINE RESOURCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT I
Authorized Official - Phone:715-825-4444
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:133 EIDER ST
Mailing Address - City:MILLTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54858
Mailing Address - Country:US
Mailing Address - Phone:715-825-4444
Mailing Address - Fax:715-825-4443
Practice Address - Street 1:133 EIDER ST
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:WI
Practice Address - Zip Code:54858
Practice Address - Country:US
Practice Address - Phone:715-825-4444
Practice Address - Fax:715-825-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001325146M00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41349000Medicaid
WI2G305UNOtherBC/BS OF WI PROVIDER NUMB
MN440268500Medicaid
MN2G305UNOtherBC/BS OF MN PROVIDER NUMB
WI41349000Medicaid
MN440268500Medicaid