FOOTVILLE FIRE DEPT & EMS NPI 1003019704

Ambulance (Land Transport) in Footville, WI

NPI 1003019704 Organization Ambulance Land Transport CLIA Number 52D2164431 CLIA Certificate of Waiver

NPI Profile for FOOTVILLE FIRE DEPT & EMS

Footville Fire Dept & Ems is a provider established in Footville, Wisconsin specializing in ambulance (land transport) . The NPI number of Footville Fire Dept & Ems is 1003019704 and was assigned on June 2007. The practitioner's primary taxonomy code is 3416L0300X. The provider is registered as an organization and their NPI record was last updated 13 years ago. The authorized official of this NPI record is Mr. Dan Jacobs (Fire Chief)

The CLIA number of Footville Fire Dept & Ems is 52D2164431 registered as a "ambulance" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Footville Fire Dept & Ems to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1003019704

Provider NameFOOTVILLE FIRE DEPT & EMS
Provider Location Address252 NORTH GILBERT STREET FOOTVILLE, WI 53537
Provider Mailing AddressPO BOX 246 FOOTVILLE, WI 53537
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date06-08-2007
Last Update Date03-18-2009


Primary Taxonomy

Taxonomy Code3416L0300X
ClassificationAmbulance
TypeTransportation Services
SpecializationLand Transport

Business Address

FOOTVILLE FIRE DEPT & EMS
252 NORTH GILBERT STREET
FOOTVILLE, WI
ZIP 53537
Phone: (608) 876-6118

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Mailing Address

FOOTVILLE FIRE DEPT & EMS
PO BOX 246
FOOTVILLE, WI
ZIP 53537
Phone: (608) 876-6118



Authorized Official

Authorized Official NameMR. DAN JACOBS
Authorized Official TitleFIRE CHIEF
Authorized Official Phone(608) 876-6118

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003019704 is:

CLIA Number52D2164431
Facility TypeAMBULANCE
Certificate TypeCertificate of Waiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
41350800MEDICAID (05)WI
000085962MEDICARE ID-TYPE UNSPECIFIED (04)WI
000085962MEDICARE PIN (08)WI
000083053MEDICARE PIN (08)WI

NPI Validation Check Digit Calculation


The following table explains step by step the NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1003019704
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003011870
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 1 + 1 + 8 + 7 + 0 + 24 = 46
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 46 = 44

The NPI number 1003019704 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Footville Fire Dept & Ems is registered as an entity type code: 2. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.