1699853788 NPI number — BOYD EDSON DELMAR FD AMBULANCE

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 1699853788 NPI number — BOYD EDSON DELMAR FD AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOYD EDSON DELMAR FD AMBULANCE
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:
1699853788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-667-3255
Provider Business Mailing Address Fax Number:
715-667-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S OSHKOSH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-667-3255
Provider Business Practice Location Address Fax Number:
715-667-3031
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUPPLE
Authorized Official First Name:
FORREST
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
AMBULANCE DIRECTOR
Authorized Official Telephone Number:
715-667-3255

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  6000352 , 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)

  • Identifier: 41336400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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