Provider Demographics
NPI:1306149208
Name:CASSVILLE VOLUNTEER FIRE DEPT AND RESCUE SQUAD
Entity type:Organization
Organization Name:CASSVILLE VOLUNTEER FIRE DEPT AND RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-725-5875
Mailing Address - Street 1:2715 W FRANK ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2593
Mailing Address - Country:US
Mailing Address - Phone:877-642-9543
Mailing Address - Fax:
Practice Address - Street 1:310 W. AMELIA STREET
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53806-9735
Practice Address - Country:US
Practice Address - Phone:608-725-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001017146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41317600Medicaid