Provider Demographics
NPI:1124695069
Name:EMERGENCY RESCUE SQUAD INC
Entity type:Organization
Organization Name:EMERGENCY RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-735-3261
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-0547
Mailing Address - Country:US
Mailing Address - Phone:715-735-3261
Mailing Address - Fax:
Practice Address - Street 1:2710 WOLESKE RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-3844
Practice Address - Country:US
Practice Address - Phone:715-735-3261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport