VILLAGE OF CAMP DOUGLAS (NPI# 1649812041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649812041 |
| Entity Type | Organization |
| Organization Name | VILLAGE OF CAMP DOUGLAS |
| Other Organization Name | CAMP DOUGLAS FIRE AND RESCUE |
| Practice Address |
304 Center St Camp Douglas WI 54618-2800 |
| Mailing Address |
Po Box 200 Camp Douglas WI 54618-0200 |
| Practice Telephone | 6084273809 |
| Mailing Telephone | 6085420346 |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2020-06-03 |
| Authorized Official Name | JAMES CHARLES NEWLUN (FIRE CHIEF) |
| Authorized Official Telephone | 6084273809 |
| Authorized Official Credential | AEMT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3416L0300X |
Ambulance Specialization: Land Transport |
Transportation Services |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | BLS EMS LICENSE | 6604999 | 01 |
| Other Name | Type Code |
|---|---|
| Camp Douglas Fire and Rescue | Doing Business As Name - Organization |
| Street Address |
304 CENTER ST |
| City | CAMP DOUGLAS |
| State | WI |
| Zip Code | 54618-2800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295780419 | Camp Douglas Rescue, Inc. | Ambulance | 302 Center St, Camp Douglas, WI 54618 | 2006-05-24 |
| 1932333945 | Brett Hunter | Military Health Care Provider | 100 Independence Dr, Medical Aid Station, Bldg 418, Camp Douglas, WI 54618-5001 | 2009-05-05 |
| 1679754907 | Patricia Ann Johnson | Licensed Practical Nurse | 30582 Horizon Ave, Camp Douglas, WI 54618-8534 | 2007-11-15 |
| 1649608977 | Briana Rose Kortbein | Registered Nurse | 17143 Itasca Rd, Camp Douglas, WI 54618-8547 | 2013-10-23 |
| 1477076503 | Easier Living Consultants LLC | Durable Medical Equipment & Medical Supplies | N10094 2nd Ave, Camp Douglas, WI 54618-9745 | 2017-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477076503 | Easier Living Consultants LLC | Durable Medical Equipment & Medical Supplies | N10094 2nd Ave, Camp Douglas, WI 54618-9745 | 2017-07-20 |
| 1649608977 | Briana Rose Kortbein | Registered Nurse | 17143 Itasca Rd, Camp Douglas, WI 54618-8547 | 2013-10-23 |
| 1679754907 | Patricia Ann Johnson | Licensed Practical Nurse | 30582 Horizon Ave, Camp Douglas, WI 54618-8534 | 2007-11-15 |
| 1295780419 | Camp Douglas Rescue, Inc. | Ambulance | 302 Center St, Camp Douglas, WI 54618 | 2006-05-24 |
| 1932333945 | Brett Hunter | Military Health Care Provider | 100 Independence Dr, Medical Aid Station, Bldg 418, Camp Douglas, WI 54618-5001 | 2009-05-05 |
| Taxonomy Code | 3416L0300X |
| Grouping | Transportation Services |
| Classification | Ambulance |
| Specialization | Land Transport |
| Definition to come... |
| Notes: [1/1/2005: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295780419 | Camp Douglas Rescue, Inc. | Ambulance | 302 Center St, Camp Douglas, WI 54618 | 2006-05-24 |
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| Find all providers with the same taxonomy | ||||
| City | CAMP DOUGLAS |
| Zip Code | 54618 |
Please comment or provide details below to improve the information on VILLAGE OF CAMP DOUGLAS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.