Provider Demographics
NPI:1487608295
Name:TWIN BRIDGE RESCUE SQUAD INC
Entity type:Organization
Organization Name:TWIN BRIDGE RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-854-2942
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-0745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W11280 COUNTY ROAD X
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-8004
Practice Address - Country:US
Practice Address - Phone:715-854-2942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0101OtherJOHN DEERE
WI41360000Medicaid
000080023OtherADVOCARE MCHMO
000080023OtherADVOCARE MCHMO
=========012OtherVALLEY HEALTH PLAN
000080023Medicare ID - Type UnspecifiedMEDICARE
WI41360000Medicaid