William M Icard Jr.

Primary specialty

Basic Emergency Medical TechnicianTaxonomy code 146N00000X

License

70104929 Issued in WI

Practice address

1679 County Road H
Deer Park, WI 54007-7102

Phone

(715) 607-0392

NPI assigned

Jul 29, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Midwest Ridesource LLC

  • Non-emergency Medical Transport (VAN)
  • New Richmond, WI
  • NPI 1396493938
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1245849850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34",
            "city": "DEER PARK",
            "state": "WI",
            "postal_code": "540070034",
            "telephone_number": "715-607-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1679 COUNTY ROAD H",
            "city": "DEER PARK",
            "state": "WI",
            "postal_code": "540077102",
            "telephone_number": "715-607-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICARD",
        "first_name": "WILLIAM",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-29",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "WI",
            "license": "70104929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anesthetists Inc. of Wisconsin
• Lisa Lynn McBrayer, CRNA

• Basic Emergency Medical Technician in Deer Park, WI
• Providers in Deer Park, WI by specialty
• Basic Emergency Medical Technician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.