Organization
LAKE COUNTRY FIRE & RESCUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW FENNIG (FIRE CHIEF)
(262) 303-4531
Entity
Organization
Contact information
Practice address
115 MAIN STREET, DELAFIELD, WI 53018-1308
(262) 646-6235
Mailing address
PO BOX 457, WHEELING, IL 60090-0457
(847) 577-8811
(336) 510-5894
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6604884
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457689051
ANTHEM BLUE CROSS BLUE SHIELD
WI
05
—
1457689051
—
WI
Enumeration date
11/20/2009
Last updated
10/27/2025
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