NPIMap

Organization Active NPI

Menominee Indian Tribe of Wisconsin

  • Ambulance
  • Keshena, WI
National Provider Identifier
1508808643
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
6001236 Issued in WI
Legal business name
MENOMINEE INDIAN TRIBE OF WISCONSIN
Practice address
W3275 Wolf River Road
Keshena, WI 54135
Phone
(715) 799-3361
Fax
(715) 799-3099
NPI assigned
Jun 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Authorized official

Name
Jerry L Waukau Sr.
Title
Health Administrator
Phone
(715) 799-3361

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 6001236 WI Primary

Addresses

Primary practice location

W3275 Wolf River Road
Keshena, WI 54135

Mailing address

PO Box 970
Keshena, WI 54135-0970
Phone (715) 799-3361

Other names 1

  • Menominee Tribal Rescue Service Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120313000210 WI Part B Supplier - Ambulance Service Supplier 2668459264 Practice locations: Keshena, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Menominee Tribl Res SQ7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1508808643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "541350970",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3275 WOLF RIVER ROAD",
            "city": "KESHENA",
            "state": "WI",
            "postal_code": "54135",
            "telephone_number": "715-799-3361",
            "fax_number": "715-799-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENOMINEE INDIAN TRIBE OF WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "WAUKAU",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "HEALTH ADMINISTRATOR",
        "authorized_official_telephone_number": "715-799-3361",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "WI",
            "license": "6001236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Menominee Tribal Rescue Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keshena, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.