Provider Demographics
NPI:1447250428
Name:CROSS PLAINS AREA EMERGENCY MEDICAL SERVICE
Entity type:Organization
Organization Name:CROSS PLAINS AREA EMERGENCY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J. TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-798-2720
Mailing Address - Street 1:2027 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-9610
Mailing Address - Country:US
Mailing Address - Phone:608-798-2720
Mailing Address - Fax:608-798-0905
Practice Address - Street 1:2027 PARK ST
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528-9610
Practice Address - Country:US
Practice Address - Phone:608-798-2720
Practice Address - Fax:608-798-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001351146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty