Organization
BLOOMFIELD GENOA CITY FIRE & RESCUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD POLTERMANN (FIRE CHIEF)
(262) 279-2033
Entity
Organization
Contact information
Practice address
N 1113 CLOVER RD., PELL LAKE, WI 53157
(262) 279-2033
Mailing address
395 W LAKE ST, ELMHURST, IL 60126-1508
(630) 530-2988
(630) 903-2830
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6001223
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
396005800001
—
WI
01
—
39600580018
BCBS
WI
Enumeration date
10/23/2006
Last updated
08/22/2020
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