Random Lake Fire Department

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

60-01170 Issued in WI

Legal business name

RANDOM LAKE FIRE DEPARTMENT

Practice address

718 N Spring St
Random Lake, WI 53075-1725

Phone

(920) 994-9817

Fax

(920) 994-2678

NPI assigned

Oct 31, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Blaine Werner

Title

EMS Director

Phone

(920) 994-9817

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174514103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 N SPRING ST",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751725",
            "telephone_number": "920-994-9817",
            "fax_number": "920-994-2678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 N SPRING ST",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751725",
            "telephone_number": "920-994-9817",
            "fax_number": "920-994-2678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOM LAKE FIRE DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WERNER",
        "authorized_official_first_name": "BLAINE",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "920-994-9817",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "60-01170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41310700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Junge Mueller, OTR
• Carli V Mueller
• Richard Polk, PT
• Prohealth Chiropractic Center S.C.
• Random Lake Dentistry, Inc
• Random Lake Fire Department
• Random Lake Medical Center LLC
• Random Lake Spine & Sports Clinic
• Abby Lynn Risse, PT
• Marlena Elizabeth Salazar, PT

• Land Ambulance in Random Lake, WI
• Providers in Random Lake, WI by specialty
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.