Organization
RANDOM LAKE FIRE DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BLAINE WERNER (EMS DIRECTOR)
(920) 994-9817
Entity
Organization
Contact information
Practice address
718 N SPRING ST, RANDOM LAKE, WI 53075-1725
(920) 994-9817
(920) 994-2678
Mailing address
718 N SPRING ST, RANDOM LAKE, WI 53075-1725
(920) 994-9817
(920) 994-2678
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
60-01170
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41310700
—
WI
Enumeration date
10/31/2005
Last updated
08/22/2020
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