Provider Demographics
NPI:1316086002
Name:RYAN BROS FORT ATKINSON LLC
Entity type:Organization
Organization Name:RYAN BROS FORT ATKINSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-240-0171
Mailing Address - Street 1:922 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1834
Mailing Address - Country:US
Mailing Address - Phone:608-257-9591
Mailing Address - Fax:608-257-9594
Practice Address - Street 1:1210 ARNDT ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2646
Practice Address - Country:US
Practice Address - Phone:920-691-0060
Practice Address - Fax:920-691-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41359300Medicaid
WI000081024Medicare ID - Type Unspecified