1023424173 NPI number — BOSCOBEL RESCUE SQUAD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023424173 NPI number — BOSCOBEL RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSCOBEL RESCUE SQUAD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023424173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSCOBEL
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53805-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-485-0263
Provider Business Mailing Address Fax Number:
608-375-2662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSCOBEL
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53805-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-375-2662
Provider Business Practice Location Address Fax Number:
608-375-2662
Provider Enumeration Date:
07/09/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CASHMAN
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
SERVICE DIRECTOR
Authorized Official Telephone Number:
608-485-0263

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6000136 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)