Village of Blanchardville

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

VILLAGE OF BLANCHARDVILLE

Practice address

208 Mason Street
Blanchardville, WI 53516

Phone

(608) 523-4521

Fax

(608) 523-4321

NPI assigned

Oct 11, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Laura Ellen Palmer, AEMT

Title

Director / Chief

Phone

(608) 523-4321

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• BLANCHARDVILLE FIRE DEPARTMENT AMBULANCE SERVICE Doing business as
• Blanchardville Fire Department and EMS Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

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

CLIA laboratory certificates

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1255529574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 MASON STREET",
            "address_2": "PO BOX 314",
            "city": "BLANCHARDVILLE",
            "state": "WI",
            "postal_code": "53516",
            "telephone_number": "608-523-4521",
            "fax_number": "608-523-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 MASON STREET",
            "city": "BLANCHARDVILLE",
            "state": "WI",
            "postal_code": "53516",
            "telephone_number": "608-523-4521",
            "fax_number": "608-523-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF BLANCHARDVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "DIRECTOR / CHIEF",
        "authorized_official_telephone_number": "608-523-4321",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "AEMT"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41342500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BLANCHARDVILLE FIRE DEPARTMENT AMBULANCE SERVICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blanchardville Fire Department and EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Renee Schultz, D.C.
• Kaylee Sefcovic
• Jerome E Simmons, PA
• Tina L. Steiner, OTR
• The Monroe Clinic, Inc.
• Paulette M Wijas Yerges

• Land Ambulance in Blanchardville, WI
• Providers in Blanchardville, WI by specialty
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (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.