NPIMap

Organization Active NPI

Black River Falls Fire Dept

  • Land Ambulance
  • Black River Falls, WI
National Provider Identifier
1871582999
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
60-00828 Issued in WI
Legal business name
BLACK RIVER FALLS FIRE DEPT
Practice address
30 S Water St
Black River Falls, WI 54615-1716
Phone
(715) 284-2656
Fax
(715) 284-4227
NPI assigned
Oct 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Authorized official

Name
Jody Frederick Stoker, AEMT
Title
Fire Chief
Phone
(715) 284-2656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 60-00828 WI Primary

Addresses

Primary practice location

30 S Water St
Black River Falls, WI 54615-1716

Mailing address

PO Box 455
Black River Falls, WI 54615-0455
Phone (715) 284-2656

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111203000055 WI Part B Supplier - Ambulance Service Supplier 9537334503 Practice locations: Black River Falls, WI

National Provider Directory

National Provider Directory

Locations

30 S Water St
Blk River Fls, WI 54615
Phone (715) 284-2656

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1871582999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 455",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546150455",
            "telephone_number": "715-284-2656",
            "fax_number": "715-284-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S WATER ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546151716",
            "telephone_number": "715-284-2656",
            "fax_number": "715-284-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER FALLS FIRE DEPT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A",
        "authorized_official_last_name": "STOKER",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "715-284-2656",
        "authorized_official_credential": "AEMT"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "60-00828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.