Active NPI
Random Lake Fire Department
- Land Ambulance
- Random Lake, WI
National Provider Identifier
1194639435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- RANDOM LAKE FIRE DEPARTMENT
- Practice address
- 718 N Spring St
Random Lake, WI 53075-1726 - Phone
- (920) 994-9817
- NPI assigned
- Oct 2, 2026
- Last updated
- Oct 2, 2026
- Organization subpart
- No
NPPES NPI Registry
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) 994-4817
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | NU | Primary |
Addresses
Primary practice location
718 N Spring St
Random Lake, WI 53075-1726
Mailing address
718 N Spring St
Random Lake, WI 53075-1726
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41310700 | Medicaid | WI | |
| 014 | Other | WI | BLUE CROSS PROVIDER |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790899200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790899200000",
"number": "1194639435",
"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": "530751726"
},
{
"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": "530751726",
"telephone_number": "920-994-9817"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RANDOM LAKE FIRE DEPARTMENT",
"organizational_subpart": "NO",
"enumeration_date": "2026-10-02",
"last_updated": "2026-10-02",
"certification_date": "2026-10-02",
"status": "A",
"authorized_official_last_name": "WERNER",
"authorized_official_first_name": "BLAINE",
"authorized_official_title_or_position": "EMS DIRECTOR",
"authorized_official_telephone_number": "920-994-4817",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41310700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER",
"identifier": "014",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Random Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.