Provider Demographics
NPI:1144277583
Name:WEST GRANT RESCUE SQUAD INC
Entity type:Organization
Organization Name:WEST GRANT RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:608-778-4718
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53804-0403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:715-834-5870
Practice Address - Street 1:136 MILL ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:WI
Practice Address - Zip Code:53804
Practice Address - Country:US
Practice Address - Phone:608-994-2385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41310200Medicaid
WI41310200Medicaid