Town of Brazeau

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

TOWN OF BRAZEAU

Practice address

12071 Parkway Rd
Pound, WI 54161-8707

Phone

(920) 897-2793

NPI assigned

May 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sue Kanack

Title

President

Phone

(920) 897-2793

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Town of Brazeau Rescue Squad Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1114970159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9151 GRAVEL LN",
            "city": "LENA",
            "state": "WI",
            "postal_code": "541399774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12071 PARKWAY RD",
            "city": "POUND",
            "state": "WI",
            "postal_code": "541618707",
            "telephone_number": "920-897-2793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF BRAZEAU",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "KANACK",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-897-2793"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIRSP",
            "identifier": "41317700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "12916",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41317700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "WI0101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVOCARE MCHMO",
            "identifier": "000080014",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Town of Brazeau Rescue Squad",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pound Community Medical Clinic S.C.
• Pound PT Clinic LLC
• Jessica Riedy
• Allison Mary Rutten
• Peter A Sytsma, PT

• All providers in Pound, WI
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.