# RANDOM LAKE FIRE DEPARTMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174514103
- **Authorized official:** MR. BLAINE WERNER (EMS DIRECTOR)
- **Authorized official phone:** (920) 994-9817

## Contact information

- **Practice address:** 718 N SPRING ST, RANDOM LAKE, WI 53075-1725
- **Practice address phone:** (920) 994-9817
- **Practice address fax:** (920) 994-2678
- **Mailing address:** 718 N SPRING ST, RANDOM LAKE, WI 53075-1725
- **Mailing address phone:** (920) 994-9817
- **Mailing address fax:** (920) 994-2678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 60-01170 | WI | Yes |

## Other

- **Enumeration date:** 10/31/2005
- **Last updated:** 08/22/2020