Provider Demographics
NPI:1730362765
Name:COUNTY OF RUSK
Entity type:Organization
Organization Name:COUNTY OF RUSK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-532-2121
Mailing Address - Street 1:311 MINER AVE E
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-2862
Mailing Address - Country:US
Mailing Address - Phone:715-532-2121
Mailing Address - Fax:715-532-2248
Practice Address - Street 1:311 MINER AVE E STE L330
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1862
Practice Address - Country:US
Practice Address - Phone:715-532-2104
Practice Address - Fax:715-532-2248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF RUSK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000764341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41330300Medicaid
WI41330300Medicaid