GREAT LAKES EMS INC. (NPI# 1972845337) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972845337 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES EMS INC. |
| Other Organization Name | ACTION SPORTS EMS |
| Practice Address |
W521 Hacker Road 410 Brillion WI 54110-4136 |
| Mailing Address |
Po Box 33 Brillion WI 54110-0033 |
| Practice Telephone | 7158894491 |
| Mailing Telephone | 7158894491 |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2020-11-06 |
| Authorized Official Name | MR. RYAN C MC CLINTOCK (DIRECTOR) |
| Authorized Official Telephone | 7158894491 |
| Authorized Official Credential | NREMT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3416L0300X |
Ambulance Specialization: Land Transport |
03 3099 | IL | Transportation Services |
| Y | 3416L0300X |
Ambulance Specialization: Land Transport |
6604935 | WI | Transportation Services |
| Other Name | Type Code |
|---|---|
| Action Sports EMS | Other Name - Individual/Organization |
| Street Address |
W521 HACKER ROAD 410 |
| City | BRILLION |
| State | WI |
| Zip Code | 54110-4136 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427691096 | Richelle L. Bruette | Technician | 306a Lavesta Ct., Brillion, WI 54110 | 2019-10-25 |
| 1659913614 | Emily M. Rataichek | Technician | 306a La Vesta Ct., Brillion, WI 54110 | 2019-10-11 |
| 1548457757 | Community Eyecare Inc | Optometrist | 950 W Ryan St, Suite A, Brillion, WI 54110 | 2007-10-02 |
| 1629120589 | Jeffery S Wierichs | Chiropractor | 114 N Main Street, Brillion, WI 54110 | 2007-01-18 |
| 1154478469 | Ascension Medical Group-fox Valley Wisconsin, Inc | Durable Medical Equipment & Medical Supplies | 708 W. Ryan St., Brillion, WI 54110 | 2007-01-05 |
| 1659377828 | Kanwar Arora | Internal Medicine | 133 Wisconsin Ave, Brillion, WI 54110 | 2005-06-22 |
| 1679729834 | Bel-regional Home Medical Inc | Eyewear Supplier (Equipment, not the service) | 964 W Ryan St, Suite E, Brillion, WI 54110 | 2008-08-07 |
| 1306004692 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 708 W Ryan St, Brillion, WI 54110 | 2008-05-23 |
| 1891963112 | Bellin Memorial Hospital Inc | Optometrist | 964 W Ryan St, Suite E, Brillion, WI 54110 | 2008-02-20 |
| 1104978055 | T.j. Kalies | Chiropractor | 114 N Main Street, Brillion, WI 54110 | 2007-01-18 |
| Find all providers in zip 54110 | ||||
| Taxonomy Code | 3416L0300X |
| Grouping | Transportation Services |
| Classification | Ambulance |
| Specialization | Land Transport |
| Definition to come... |
| Notes: [1/1/2005: title modified] |
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| 1881044964 | Central Fire & Ems District | Ambulance | 112 W Spruce St, Abbotsford, WI 54405-9734 | 2016-06-20 |
| 1013363258 | Florence Rescue Squad Ltd | Ambulance | 747 Lake Ave, Florence, WI 54121 | 2016-05-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.