# BLOOMFIELD GENOA CITY FIRE & RESCUE

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

## Provider details

- **NPI number:** 1558444828
- **Authorized official:** BRAD POLTERMANN (FIRE CHIEF)
- **Authorized official phone:** (262) 279-2033

## Contact information

- **Practice address:** N 1113 CLOVER RD., PELL LAKE, WI 53157
- **Practice address phone:** (262) 279-2033
- **Mailing address:** 395 W LAKE ST, ELMHURST, IL 60126-1508
- **Mailing address phone:** (630) 530-2988
- **Mailing address fax:** (630) 903-2830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 6001223 | WI | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 08/22/2020