Great Lakes EMS Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

03 3099 Issued in IL

Legal business name

GREAT LAKES EMS INC.

Practice address

W521 Hacker Road
410
Brillion, WI 54110-4136

Phone

(715) 889-4491

Fax

(855) 425-3066

NPI assigned

Mar 25, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Ryan C MC Clintock, NREMT

Title

Director

Phone

(715) 889-4491

Specialties & licenses 2

Addresses

Other names 1

• Action Sports EMS Other name

Locations

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1972845337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33",
            "city": "BRILLION",
            "state": "WI",
            "postal_code": "541100033",
            "telephone_number": "715-889-4491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W521 HACKER ROAD",
            "address_2": "410",
            "city": "BRILLION",
            "state": "WI",
            "postal_code": "541104136",
            "telephone_number": "715-889-4491",
            "fax_number": "855-425-3066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "124 E Cumberland St",
            "address_purpose": "LOCATION",
            "city": "Greenup",
            "state": "IL",
            "postal_code": "62428",
            "country_code": "US",
            "telephone_number": "715-889-4491",
            "fax_number": "855-425-3066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT LAKES EMS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-25",
        "last_updated": "2021-02-08",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "MC CLINTOCK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-889-4491",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NREMT"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "WI",
            "license": "6604935",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "03 3099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Action Sports EMS",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Action Sports EMS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nathan Steven Cummings, D.C.
• Linda Jean Decleene, RN
• Amy Lynn Fischer, RN
• Brooke Giltner, LAT, ATC
• Vernon Goin, D.D.S.
• Groskopp Chiropractic, SC
• William Charles Groskopp, D.C.
• David R Johnson, D.D.S.,S.C.
• Joint School District No 2 Co City & Town of Brillion
• Micah Juedes, O.D.

• All providers in Brillion, WI
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; 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.