Kickapoo Valley Rescue Squad Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

KICKAPOO VALLEY RESCUE SQUAD INC

Practice address

213 N Turner
Viola, WI 54664

Phone

(608) 627-1810

Fax

(608) 627-1815

NPI assigned

Jun 6, 2007

Organization subpart

No

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

Authorized official

Name

Sadie J Wallace

Title

Secretary

Phone

(608) 606-3932

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1508069923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95",
            "city": "VIOLA",
            "state": "WI",
            "postal_code": "546640095",
            "telephone_number": "608-627-1810",
            "fax_number": "608-627-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 N TURNER",
            "city": "VIOLA",
            "state": "WI",
            "postal_code": "54664",
            "telephone_number": "608-627-1810",
            "fax_number": "608-627-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKAPOO VALLEY RESCUE SQUAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SADIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "608-606-3932"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "WI",
            "license": "60-01171",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41348900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Cook
• Carol M Dinges, M.D.
• Matthew Wayne Hajzl, D.C.
• Patricia Karn Helgerson
• Kickapoo Area School District
• Sylvia Christine Longacre, ACUPUNCTURIST
• Mystic Acres, LLC
• Mystic Creek, LLC
• Scenic Bluffs Health Center, Inc
• Viola Health Services and Osteoporosis Center, LTD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; 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.