1760585095 NPI number — DANE COUNTY DISTRICT ONE EMS

Table of content: (NPI 1760585095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760585095 NPI number — DANE COUNTY DISTRICT ONE EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANE COUNTY DISTRICT ONE EMS
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:
1760585095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 W COMMERCIAL ST
Provider Second Line Business Mailing Address:
PO BOX 505
Provider Business Mailing Address City Name:
MAZOMANIE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53560-9596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-795-9860
Provider Business Mailing Address Fax Number:
608-795-9860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 W COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAZOMANIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53560-9596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-795-9860
Provider Business Practice Location Address Fax Number:
608-795-9860
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WICK
Authorized Official First Name:
JIM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
608-795-9860

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  60-01193 , 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: 41306000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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