Provider Demographics
NPI:1396892451
Name:MILWAUKEE COUNTY OEM-EMS
Entity type:Organization
Organization Name:MILWAUKEE COUNTY OEM-EMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-226-7303
Mailing Address - Street 1:633 W. WISCONSIN AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203
Mailing Address - Country:US
Mailing Address - Phone:414-226-7354
Mailing Address - Fax:
Practice Address - Street 1:901 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1425
Practice Address - Country:US
Practice Address - Phone:414-289-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILWAUKEE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-04
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001239146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41351500Medicaid