Provider Demographics
NPI:1447446299
Name:LONG LAKE-TIPLER RESCUE SQUAD LTD
Entity type:Organization
Organization Name:LONG LAKE-TIPLER RESCUE SQUAD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-889-4592
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54542-0137
Mailing Address - Country:US
Mailing Address - Phone:715-889-2674
Mailing Address - Fax:
Practice Address - Street 1:11098 DREAM LAKE RD
Practice Address - Street 2:
Practice Address - City:TIPLER
Practice Address - State:WI
Practice Address - Zip Code:54542
Practice Address - Country:US
Practice Address - Phone:715-889-2674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41314500Medicaid