Organization
JOHNSON CREEK FIRE EMS DEPT.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MODERACKI (VILLAGE ADMINISTRATOR)
(920) 699-2296
Entity
Organization
Contact information
Practice address
125 DEPOT ST., JOHNSON CREEK, WI 53038-0451
(920) 699-2296
Mailing address
125 DEPOT ST., JOHNSON CREEK, WI 53038-0451
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6001180
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41307600
—
WI
Enumeration date
01/03/2007
Last updated
08/22/2020
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