1831143429 NPI number — MERCER AREA AMBULANCE AND RESCUE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831143429 NPI number — MERCER AREA AMBULANCE AND RESCUE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCER AREA AMBULANCE AND RESCUE 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:
1831143429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCER
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54547-0409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5267 N VAUGHN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54547-9320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-476-2056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOUSTRA
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-562-0303

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41333300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184842370 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46301 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012415 . This is a "PHYSICIAN'S PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: WI0101 . This is a "JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000083661 . This is a "ADVOCARE MCHMO" identifier . This identifiers is of the category "OTHER".




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