| Organization Name: | RANDOM LAKE FIRE DEPARTMENT |
| NPI Number: | 1174514103 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BLAINE WERNER (EMS DIRECTOR) |
| Mailing Address: | 718 N Spring St Random Lake |
| State: | WI US |
| Postal Code: | 530751725 |
| Phone Number: | 9209949817 |
| Fax Number: | 9209942678 |
| NPI Enumeration Date: | 10/31/2005 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 60-01170 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |