Provider Demographics
NPI:1215957824
Name:MINERAL POINT RESCUE SQUAD, INC.
Entity type:Organization
Organization Name:MINERAL POINT RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:V
Authorized Official - Last Name:PROCHASKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-341-8883
Mailing Address - Street 1:907 RIDGE STREET
Mailing Address - Street 2:PO BOX 245
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-0245
Mailing Address - Country:US
Mailing Address - Phone:608-987-2752
Mailing Address - Fax:608-987-1544
Practice Address - Street 1:907 RIDGE ST
Practice Address - Street 2:
Practice Address - City:MINERAL POINT
Practice Address - State:WI
Practice Address - Zip Code:53565-1461
Practice Address - Country:US
Practice Address - Phone:608-987-2752
Practice Address - Fax:608-987-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001292146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41318200Medicaid