Spencer Area Fire and Ambulance Commission
Organization Active NPI Ambulance · Spencer, WI
NPI 1164552105 · NPPES record last updated Mar 9, 2025
Key facts
- NPI
- 1164552105
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 94083 (WI)
- Legal business name
- SPENCER AREA FIRE AND AMBULANCE COMMISSION
- Practice address
- 206 W Willow Drive
206 W Willow Drive
Spencer, WI 54479-9552 - Phone
- (715) 659-4030
- Fax
- (715) 659-4106
- NPI assigned
- Mar 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Daniel Wall
- Title
- 3Rd Assistant Chief
- Phone
- (715) 615-9596
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0985188 | Spencer Area Ambulance | Certificate of waiver | Apr 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120523000609 | WI | Part B Supplier - Ambulance Service Supplier | 4587827837 | Practice locations: Spencer, WI |
National Provider Directory
Locations
206 W Willow Dr
206 W Willow Dr
Spencer, WI 54479
Phone (715) 659-4030
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 94083 | WI | Yes |
Addresses
Primary practice location
206 W Willow Drive
206 W Willow Drive
Spencer, WI 54479-9552
Mailing address
PO Box 360
206 W Willow Drive
Spencer, WI 54479-9552
Phone (715) 659-4030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41333700 | Medicaid | WI |
Other names
- Spencer Fire Department and Ambulance Service
Other providers in Spencer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2025. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.