Dickeyville Rescue Squad Inc
Organization Active NPI Land Ambulance · Dickeyville, WI
NPI 1144399577 · NPPES record last updated Aug 2, 2021
Key facts
- NPI
- 1144399577
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- DICKEYVILLE RESCUE SQUAD INC
- Practice address
- 300 Splinter Ave
Dickeyville, WI 53808-6888 - Phone
- (608) 568-3095
- Fax
- (608) 568-3753
- NPI assigned
- Nov 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Dallas Edmund Dietzel, LICENSED AEMT
- Title
- President
- Phone
- (563) 580-0130
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040825000937 | WI | Part B Supplier - Ambulance Service Supplier | 1557335429 | Practice locations: Dickeyville, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
300 Splinter Ave
Dickeyville, WI 53808-6888
Mailing address
300 Splinter Ave
Dickeyville, WI 53808-6888
Phone (608) 568-3095
Other providers in Dickeyville, WI
All providers in Dickeyville, WI · Land Ambulance in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.