Wausaukee Rescue Squad, Inc. – Land Ambulance

Key facts

NPI: 1235307612
Entity type: Organization (NPI type 2)
Primary specialty: Land Ambulance 3416L0300X
License: 60-00091 (WI)
Legal business name: WAUSAUKEE RESCUE SQUAD, INC.
Practice address: 429 Harrison Ave.
Wausaukee, WI 54177
Phone: (715) 856-5035
Fax: (715) 856-5010
NPI assigned: Feb 19, 2008
Organization subpart: No

Authorized official

Name: Zetta C Kolf
Title: Authorized Official
Phone: (414) 949-1213

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
52D0982546	Wausaukee Rescue Squad 429 Harrison St, Wausaukee, WI 54177	Certificate of waiver	Jan 29, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040721000237	WI	Part B Supplier - Ambulance Service Supplier	4284614314	Practice locations: Wausaukee, WI

National Provider Directory

Locations

9401 W Brown Deer Rd
#101
Milwaukee, WI 53224

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Land Ambulance	3416L0300X	60-00091	WI	Yes

Addresses

Primary practice location

429 Harrison Ave.
Wausaukee, WI 54177

Mailing address

P.O. Box 318
429 Harrison Ave
Wausaukee, WI 54177
Phone (715) 856-5035

Other identifiers

Identifier	Type	State	Issuer
41329000	Medicaid	WI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 6, 2024.

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1235307612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 318",
            "address_2": "429 HARRISON AVE",
            "city": "WAUSAUKEE",
            "state": "WI",
            "postal_code": "54177",
            "telephone_number": "715-856-5035",
            "fax_number": "715-856-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 HARRISON AVE.",
            "city": "WAUSAUKEE",
            "state": "WI",
            "postal_code": "54177",
            "telephone_number": "715-856-5035",
            "fax_number": "715-856-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUSAUKEE RESCUE SQUAD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-19",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "KOLF",
        "authorized_official_first_name": "ZETTA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "414-949-1213"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "60-00091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41329000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausaukee, WI

All providers in Wausaukee, 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 May 6, 2024. 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.

Verify at the official NPI Registry.