Provider Demographics
NPI:1194877845
Name:KETTLE MORAINE EMERGENCY MEDICAL SERVICES INC
Entity type:Organization
Organization Name:KETTLE MORAINE EMERGENCY MEDICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHETTAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-542-9699
Mailing Address - Street 1:380 BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1751
Mailing Address - Country:US
Mailing Address - Phone:262-542-9699
Mailing Address - Fax:262-549-9177
Practice Address - Street 1:380 BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1751
Practice Address - Country:US
Practice Address - Phone:262-542-9699
Practice Address - Fax:262-549-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60013413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41346700Medicaid
WI000081391Medicare PIN