1912009754 NPI number — REEDSBURG AREA AMBULANCE SERVICE,INC.

Table of content: (NPI 1912009754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912009754 NPI number — REEDSBURG AREA AMBULANCE SERVICE,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REEDSBURG AREA AMBULANCE SERVICE,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:
1912009754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REEDSBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53959-0412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-524-3074
Provider Business Mailing Address Fax Number:
608-524-3074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 RAILROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53959-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-524-3074
Provider Business Practice Location Address Fax Number:
608-524-3074
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHOMMER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
608-524-3074

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6001024 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010294860 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41322500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874700800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com