1588141345 NPI number — SUPERIOR AIR-GROUND AMBULANCE SERVICES OF WISCONSIN, INC

Table of content: MS. EMELIA S. WHITEAKER ATC, PES (NPI 1619319381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588141345 NPI number — SUPERIOR AIR-GROUND AMBULANCE SERVICES OF WISCONSIN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR AIR-GROUND AMBULANCE SERVICES OF WISCONSIN, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588141345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
395 W LAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-538-1887
Provider Business Mailing Address Fax Number:
630-903-2835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALWORTH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53184-9680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-234-0170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GODDEN
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
PATE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
630-903-2401

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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